CHAD BRIAN GOODERHAM (NPI# 1639153091) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639153091 |
| Entity Type | Individual |
| Full Name | CHAD BRIAN GOODERHAM |
| Credential | FNP |
| Practice Address |
1060 Gaffney Rd Fort Wainwright AK 99703-5001 |
| Mailing Address |
1123 Shannon Dr Fairbanks AK 99701-3811 |
| Practice Telephone | 9073535286 |
| Mailing Telephone | 9074575158 |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 363LF0000X |
Nurse Practitioner Specialization: Family |
1927-033 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| X | 363LF0000X |
Nurse Practitioner Specialization: Family |
WI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1060 GAFFNEY RD |
| City | FORT WAINWRIGHT |
| State | AK |
| Zip Code | 99703-5001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033191192 | Elizabeth Ann Mittelstaedt | Registered Nurse | 1060 Gaffney Rd, Commander, Usa-meddac-ak, Attn: Mcuc-mmd-qm, Fort Wainwright, AK 99703-5001 | 2005-11-15 |
| 1952858615 | Patrick Degen Bushman | Physician Assistant | 1060 Gaffney Rd, #7440, Fort Wainwright, AK 99703-5002 | 2016-09-09 |
| 1043764939 | Laurence Preston Keim | Physician Assistant | 1060 Gaffney Rd, Fort Wainwright, AK 99703-5002 | 2016-08-08 |
| 1275985152 | Monica Wyatt | Nurse Practitioner | 1060 Gaffney Rd, Fort Wainwright, AK 99703-5002 | 2016-07-05 |
| 1700235546 | Tyler Tubbs | Dental Assistant | 1060 Gaffney Rd, 1055, Fort Wainwright, AK 99703-5002 | 2016-06-10 |
| 1285037796 | Tina Syfert | Nurse Practitioner | 1060 Gaffney Rd, Fort Wainwright, AK 99703-5002 | 2014-09-29 |
| 1841617586 | Keng Yu Chen | Dentist | 1060 Gaffney Rd, #7500, Fort Wainwright, AK 99703-5001 | 2014-03-19 |
| 1831539378 | Laina Gay Cafego | Family Medicine | 1060 Gaffney Rd, Bassett Army Community Hospital, Fort Wainwright, AK 99703 | 2013-06-28 |
| 1467890798 | Jennifer Myaeng | Pediatrics | 1060 Gaffney Rd, Fort Wainwright, AK 99703-5002 | 2013-06-09 |
| 1598100745 | Andrea Christina Knievel | General Practice | 1060 Gaffney Rd, Fort Wainwright, AK 99703-5002 | 2013-05-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144866435 | Rebecca P Conner | Registered Nurse | Bach, 1060 Gafney Rd, Ft Wainwright, AK 99703 | 2019-11-21 |
| 1881242030 | Stephanie Morse | Counselor | Bldg 3406 Alder Ave, Ft. Wainwright, AK 99703 | 2019-08-30 |
| 1801376702 | Matthew Gerard Somma | Physician Assistant | 1-25 Attack Reconnaissance Bn, Fort Wainwright, AK 99703 | 2018-08-20 |
| 1003268657 | Brandy Tristan | Dental Hygienist | Bldg 3406, Troop Dental Clinic, Ft. Wainwright, AK 99703 | 2016-07-07 |
| 1174998918 | Jeffrey Grace | Physician Assistant | Bassett Army Medical Center (kamish Clinic), 1060 Gaffney Rd, Ft Wainwright, AK 99703 | 2015-12-04 |
| 1073999215 | Melanie Anne Whalen | Dentist | 4055 Tamarak Dr, Ft Wainwright, AK 99703 | 2015-08-10 |
| 1790183176 | Sally Jane Rall | Counselor | 3406 Adler Ave, Fairbanks, AK 99703 | 2014-12-16 |
| 1083029193 | Francesann Hill | General Practice | 3214 East Santiago Avenue, Apo, AP 99703 | 2014-06-26 |
| 1669883146 | Amber Benton | Psychiatry & Neurology | 4005-4007 602nd St, Fort Wainwright, AK 99703 | 2014-05-18 |
| 1952720898 | Allison Hubert | Occupational Therapist | 3410 Rhineland Ave, Rm 108, Fort Wainwright, AK 99703 | 2014-04-08 |
| Find all providers in zip 99703 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619256518 | Sheila Ann Medina | Nurse Practitioner | 1060 Gaffney Road #7410, Fort Wainwright, AK 99703-7400 | 2011-08-09 |
| 1700857034 | Danilo C. Motas | Nurse Practitioner | 1400 Gaffney Rd, Fort Wainwright, AK 99703-1364 | 2006-01-26 |
| 1891243374 | Lorna D Newman-hill | Nurse Practitioner | 4076 Neely Rd, Fort Wainwright, AK 99703-1376 | 2016-09-14 |
| 1285037796 | Tina Syfert | Nurse Practitioner | 1060 Gaffney Rd, Fort Wainwright, AK 99703-5002 | 2014-09-29 |
| 1093758369 | Audry Marie Torres | Nurse Practitioner | 1060 Gaffney Rd, Fort Wainwright, AK 99703-5002 | 2006-06-14 |
| 1962472977 | Heather Guess | Nurse Practitioner | 1060 Gaffney Rd, Bassett Army Community Hospital, Fort Wainwright, AK 99703-7401 | 2006-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497355390 | Delia M. Reyes | Nurse Practitioner | 705 2nd St., Cordova, AK 99574 | 2020-10-29 |
| 1396342895 | Stacey Reynolds Dahl | Nurse Practitioner | 103 Fram Treet, Petersburg, AK 99833-0589 | 2020-10-07 |
| 1912514647 | Kaveri Bharti | Nurse Practitioner | 2900 Morgan Loop, Anchorage, AK 99516-1427 | 2020-09-27 |
| 1831709070 | China Kay Larson | Nurse Practitioner | 9402 Endicott St, Anchorage, AK 99502-1342 | 2020-08-03 |
| 1144847021 | Stephanie Anne Olah Packard | Nurse Practitioner | 6929 Crawford St, Anchorage, AK 99502-2728 | 2020-06-26 |
| 1134743370 | Matthew G Horgan | Nurse Practitioner | 700 Chief Eddie Hoffman Hwy, Bethel, AK 99559-0827 | 2020-06-03 |
| 1417585902 | Shelley Wantaja | Nurse Practitioner | 689 E Eklutna St, Palmer, AK 99645-6116 | 2020-03-30 |
| 1437787363 | Naomi Tonje Johnson | Nurse Practitioner | 5428 E Rebecca Nicole St Unit C, Wasilla, AK 99654-0002 | 2020-03-27 |
| 1235789322 | Halley Marie Fondren | Nurse Practitioner | Page Street, Soldotna, AK 99669-2634 | 2019-09-19 |
| 1710535380 | Peter Harvey | Nurse Practitioner | 755 Knightsbridge Rd, Fairbanks, AK 99709-2477 | 2019-08-27 |
| Find all providers with the same taxonomy | ||||
| City | FORT WAINWRIGHT |
| Zip Code | 99703 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.