Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 31196 | TN |
NPI | 1003560715 |
---|---|
Provider Name | Ms. Lakesha Monique Goodwin |
First Address | Murfreesboro, TN 37128-5366 |
Second Address | Murfreesboro, TN 37128-5366 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2022 |
Last Update Date | 10/02/2022 |