Kim Dale Goodrum, R.N.

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

696742 Issued in CA

Practice address

825 Palmilla Dr
Modesto, CA 95356-1152

Phone

(209) 572-3243

NPI assigned

Jun 8, 2008

Last updated

Jun 8, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1212883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212883200000",
    "number": "1558520114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 PALMILLA DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953561152",
            "telephone_number": "209-572-3243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 PALMILLA DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953561152",
            "telephone_number": "209-572-3243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODRUM",
        "first_name": "KIM",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "credential": "R.N.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-08",
        "last_updated": "2008-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "696742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harris Michael Goodman, MD
• Scott Goodreau, M.D.
• Kathleen Marion Goodrich, LCSW
• Macey Goodrich
• Beth Goodridge, RD
• Violet Goods
• Roger Goorley
• Gopika Gangupantula, MD, Inc. (Valley Diabetes & Obesity)
• Mary Jean Goralka, MFT
• Grace Gordon

• Psychiatric/Mental Health Registered Nurse in Modesto, CA
• Providers in Modesto, CA by specialty
• Psychiatric/Mental Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.