| NPI | 1740503689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ANN GOODMAN Owner 202-684-7167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MD R156558) | |
| Enumeration Date | 2010-03-07 |
| Last Update Date | 2025-07-14 |