Provider Demographics
NPI:1811653678
Name:GOODRICH, KRISTA MICHELLE
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MICHELLE
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 RUSH RUN RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLDSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25234-7618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:898 RUSH RUN RD
Practice Address - Street 2:
Practice Address - City:ARNOLDSBURG
Practice Address - State:WV
Practice Address - Zip Code:25234-7618
Practice Address - Country:US
Practice Address - Phone:304-354-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant