Alicia Dorethea Goodman, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

906660 Issued in MS

Practice address

4300B W Railroad St
Gulfport, MS 39501-2568

Phone

(228) 822-6722

NPI assigned

Oct 9, 2024

Last updated

Oct 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Alicia Dorethea Wells Former name

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hattiesburg HB Medical Services LLC

  dba Merit Health Wesley

  • Emergency Medicine Physician
  • Hattiesburg, MS
  • NPI 1699456376
  Medicare reassignment NPD
• Memorial Hospital at Gulfport

  • Urology Physician
  • Gulfport, MS
  • NPI 1093142598
  Medicare reassignment NPD
• Memorial Hospital at Gulfport

  dba Memorial Surgery Center Cedar Lake

  • General Acute Care Hospital
  • Biloxi, MS
  • NPI 1215546635
  NPD
• Memorial Hospital at Gulfport

  dba Memorial Emergency Physicians

  • Emergency Medicine Physician
  • Gulfport, MS
  • NPI 1962780379
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1728432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1346069960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3211 ROSEWOOD DR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394014517",
            "telephone_number": "601-631-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300B W RAILROAD ST",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012568",
            "telephone_number": "228-822-6722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "ALICIA",
        "middle_name": "DORETHEA",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-09",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "906660",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICIA",
            "last_name": "WELLS",
            "middle_name": "DORETHEA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bradley Goldenberg, MD
• Brooke Kayla Gonzales, PHARMD
• Paola Nicol Gonzalez de Jesus
• Good Heart Professional Counseling
• Good Medicine (Lyman Pharmacy)
• Anne Goodman
• Magdy Gorgi-Mikhail, MD
• Laura Gottschalck, LCSW
• Johntre L Goudy, DMD
• Jeremy M Goulet, D.C.

• Family Nurse Practitioner in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.