Provider Demographics
NPI:1821772070
Name:GOODSON, JOHN (AGACNP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:GOODSON
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MULBERRY ST SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5720
Mailing Address - Country:US
Mailing Address - Phone:828-757-5100
Mailing Address - Fax:
Practice Address - Street 1:470 FOREST GROVE RD
Practice Address - Street 2:
Practice Address - City:VILAS
Practice Address - State:NC
Practice Address - Zip Code:28692-9306
Practice Address - Country:US
Practice Address - Phone:828-964-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021824363LA2100X
NC277688163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine