Provider Demographics
NPI:1194107920
Name:GOODMAN, TERRA R (LPN)
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:R
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 COLONIAL CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-3924
Mailing Address - Country:US
Mailing Address - Phone:931-646-7578
Mailing Address - Fax:931-879-9938
Practice Address - Street 1:240 COLONIAL CIR
Practice Address - Street 2:SUITE A
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3924
Practice Address - Country:US
Practice Address - Phone:931-646-7578
Practice Address - Fax:931-879-9938
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000060426164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse