Goodman, Kelly A
Goodman, Kelly A is an sole proprietor health care provider with primary practice located at 4701 Sangamore Road Suite 5207, Bethesda MD 20816-2529. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Goodman, Kelly A can be contacted via phone (202) 684-7167.Contact Information
Primary practice address
4701 Sangamore Road Suite 5207
Bethesda MD 20816-2529
Phone: (202) 684-7167
Fax: (240) 483-0441
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Adult Health | 363LA2200X | RN966360 | District of Columbia |
| Physician Assistants & Advanced Practice Nursing Providers / Adult Health | 363LA2200X | R156558 | Maryland |
| Physician Assistants & Advanced Practice Nursing Providers / Adult Health | 364SA2200X | R156558 | Maryland |
Profile Details
| NPI number | 1639396914 |
|---|---|
| LBN Legal business name | Goodman, Kelly A |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 19th, 2007 |
| Last updated | Mar 7th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639396914 | NPPES |
| Maryland | MEDICAID | 413209200 | |
| Maryland | Other | 44330062 | |
| Maryland | MEDICAID | 038745900 | |
| Maryland | MEDICAID | 1639396914 |
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