Provider Demographics
NPI:1154049989
Name:GOODNIGHT FAMILY HEALTHCARE PLLC
Entity type:Organization
Organization Name:GOODNIGHT FAMILY HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:LAUREL
Authorized Official - Last Name:GOODNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:479-216-1016
Mailing Address - Street 1:113 MYERS LN
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-8944
Mailing Address - Country:US
Mailing Address - Phone:479-216-1016
Mailing Address - Fax:
Practice Address - Street 1:403 MORROW ST N STE E
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4324
Practice Address - Country:US
Practice Address - Phone:479-385-3055
Practice Address - Fax:479-385-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR288894762Medicaid
AR2I7546OtherMEDICARE