Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 057192 | MO |
NPI | 1063742419 |
---|---|
Provider Name | Ms. Shirley Ann Goode |
First Address | Kansas City, MO 64154-1465 |
Second Address | Kansas City, MO 64154-1465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2010 |
Last Update Date | 09/02/2010 |