Provider Demographics
NPI:1285704601
Name:GOODWIN, TRENA JILL (PMHCNS-BC, APRN)
Entity type:Individual
Prefix:MRS
First Name:TRENA
Middle Name:JILL
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PMHCNS-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9973 TIMBERS DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5551
Mailing Address - Country:US
Mailing Address - Phone:513-791-2046
Mailing Address - Fax:
Practice Address - Street 1:10200 ALLIANCE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-4753
Practice Address - Country:US
Practice Address - Phone:513-891-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.121852364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2245145Medicaid
OHRX.01444OtherPRESCRIPTIVE AUTHORITY