Active NPI
Nicole Goodman, ATC, LAT
- Student in an Organized Health Care Education/Training Program
- Tyler, TX
National Provider Identifier
1609224393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- AT6334
- Practice address
- 13172 State Highway 64 E
Tyler, TX 75707-5340 - Phone
- (502) 542-0583
- NPI assigned
- Jun 2, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | AT6334 | TX | Primary |
Addresses
Primary practice location
13172 State Highway 64 E
Tyler, TX 75707-5340
Mailing address
5613 Oakmeadow Dr
Apt 906
Fort Worth, TX 76132-2469
Phone (502) 542-0583
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT6334 | TX | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464825600000",
"number": "1609224393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5613 OAKMEADOW DR",
"address_2": "APT 906",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761322469",
"telephone_number": "502-542-0583"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13172 STATE HIGHWAY 64 E",
"city": "TYLER",
"state": "TX",
"postal_code": "757075340",
"telephone_number": "502-542-0583"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMAN",
"first_name": "NICOLE",
"credential": "ATC, LAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-02",
"last_updated": "2016-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "TX",
"license": "AT6334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.