KELLY RAE GOODWIN (NPI# 1841761798) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841761798 |
| Entity Type | Individual |
| Full Name | KELLY RAE GOODWIN |
| Credential | APRN |
| Practice Address |
636 Hamlet Dr Port Orange FL 32127-5986 |
| Practice Telephone | 4055689165 |
| Mailing Telephone | 4055689165 |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2018-12-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
AG12180060 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467068999 | Kelly Ross Goodwin | Social Worker | 2542 Ne Courtney Dr Ste 101, Bend, OR 97701-7685 | 2020-09-21 |
| 1972078392 | Kelly Marie Goodwin | Behavioral Analyst | 5 Revere Dr Ste 120, Northbrook, IL 60062-8005 | 2018-10-11 |
| 1093006884 | Kelly Eh Goodwin | Nurse Practitioner | 55 Fruit St, Massachusetts General Hospital, Yawkey 7b, Boston, MA 02114-2621 | 2011-04-27 |
| Street Address |
636 HAMLET DR |
| City | PORT ORANGE |
| State | FL |
| Zip Code | 32127-5986 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952918179 | Karen Lugo Morales | Massage Therapist | 1394 Dunlawton Ave, Apartment 505, Port Orange, FL 32127 | 2020-09-30 |
| 1265952568 | Compass Nutrition LLC | Dietitian, Registered | 840 Angelina Court, Port Orange, FL 32127 | 2017-06-27 |
| 1942730544 | Ambili Gopinathan Nair | Nurse Anesthetist, Certified Registered | 6216 Morning Drive, Port Orange, FL 32127 | 2017-06-15 |
| 1649707993 | Jill Lynn Sheldon | Social Worker | 3959 South Nova Road, Suiteb15, Port Orange, FL 32127 | 2017-05-17 |
| 1003350620 | Irene A Zachry | Interpreter | 6239 Yellowstone Dr. Port Orange Fl, Port Orange, FL 32127 | 2016-12-16 |
| 1427460328 | Jonathan Ivan Rodriguez Arocho | Chiropractor | 940 Village Trail, Unit 4-105, Port Orange, FL 32127 | 2014-05-27 |
| 1982015913 | Adventist Health System/sunbelt, Inc. | Clinic/Center | 1208 Dunlawton Ave, Port Orange, FL 32127 | 2014-05-13 |
| 1699105288 | Counseling & Consultation, Corp. | Early Intervention Provider Agency | 3959 S. Nova Rd., Suite 14, Port Orange, FL 32127 | 2013-11-18 |
| 1427484773 | Usv Optical Inc. | Technician/Technologist | 1800 Dunlawton Ave., Port Orange, FL 32127 | 2013-09-18 |
| 1104194018 | Jinny E Ruhlman | Marriage & Family Therapist | 4725 Dixie Dr, Ponce Inlet, FL 32127 | 2011-12-06 |
| Find all providers in zip 32127 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649871724 | Brenna Schulman | Nurse Practitioner | 6859 Sw 18th St Ste 200, Boca Raton, FL 33433-7015 | 2020-11-04 |
| 1245831726 | Sydia Spence | Nurse Practitioner | 8001 Nw 66th Ter, Tamarac, FL 33321-7015 | 2020-11-02 |
| 1598365165 | Fernande Simeon | Nurse Practitioner | 6490 Nw 55th St, Coral Springs, FL 33067-2710 | 2020-10-31 |
| 1780284596 | Corrective Spinal Care Inc | Nurse Practitioner | 6965 Piazza Grande Ave Ste 207, Orlando, FL 32835-8780 | 2020-10-30 |
| 1023617420 | John Bertram Garrett Iv | Nurse Practitioner | 5079 Garrett Rd, Malone, FL 32445-3409 | 2020-10-19 |
| 1518565894 | Karen Giselle Reyes | Nurse Practitioner | 4563 Perth Rd, West Palm Beach, FL 33415-2811 | 2020-10-09 |
| 1265039424 | Catherine Dettelbach Lake | Nurse Practitioner | 3411 Shenandoah Dr W, Orange Park, FL 32073-6631 | 2020-10-01 |
| 1417562877 | Victoria Ann Jacobs | Nurse Practitioner | 3605 Lithia Ridge Blvd, Valrico, FL 33596-6482 | 2020-09-12 |
| 1760096135 | Conciergenp | Nurse Practitioner | 1221 S 23rd Ave, Hollywood, FL 33020-5912 | 2020-09-03 |
| 1649881434 | Dr Jose A Rivera LLC | Nurse Practitioner | 110 W Citrus St, Altamonte Springs, FL 32714-2502 | 2020-08-14 |
| Find all providers with the same taxonomy | ||||
| City | PORT ORANGE |
| Zip Code | 32127 |
Please comment or provide details below to improve the information on KELLY RAE GOODWIN.
| 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.