Basic Information
| Provider Information | |||||||||
| NPI: | 1235860255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOODIN | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3395 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477323395 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1373 E SR 62 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128010800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2022 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 28244373A | IN | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 71012671A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 300064344 | 05 | IN | MEDICAID | 412840156 | 01 | IN | MEDICARE | OTHER |