Lacie Ann Goodman, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

216526 Issued in GA

Practice address

7521 Country Club Dr Apt 304
Laredo, TX 78041-3396

Phone

(912) 571-1480

NPI assigned

Aug 21, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Nurse Practitioner

State licenses

Practice roles

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.

• Mark Steven Souder, MD

  • Family Medicine Physician
  • Auburn, IN
  • NPI 1245218973
  Medicare reassignment
• Mark S. Souder, M.D.

  • Family Medicine Physician
  • Auburn, IN
  • NPI 1922287531
  NPD (past)

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

{
    "created_epoch": "1566345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566345600000",
    "number": "1477100857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7521 COUNTRY CLUB DR APT 304",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780413396",
            "telephone_number": "912-571-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7521 COUNTRY CLUB DR APT 304",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780413396",
            "telephone_number": "912-571-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "LACIE",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-21",
        "last_updated": "2019-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "216526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Gonzalez
• Victor Manuel Gonzalez Jr., M.D.
• Vilma Judith Gonzalez, LPC
• Xochitl Gonzalez
• Yesenia Gonzalez, COTA
• Virginia R. Goytia, MD
• Abigail Granger, NP
• Gloria Georgina Granger
• Grateful Primary Home Care
• Great American Home Care Services Home Health LLC

• Family Nurse Practitioner in Laredo, TX
• Providers in Laredo, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2019; 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.