Stephannie Lorene Goodrum, APRN
Individual provider Active NPI Family Nurse Practitioner · Clinton, KY
NPI 1700396405 · NPPES record last updated Oct 7, 2017
Key facts
- NPI
- 1700396405
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 3011787 (KY)
- Practice address
- 308 S Washington St Ste 200
Clinton, KY 42031-1347 - Phone
- (270) 653-0220
- Fax
- (270) 653-0221
- NPI assigned
- Oct 7, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 27
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Upperline Healthcare PC
Vital Path Care PC
Advanced Foot Care LLP
Practice addresses (Care Compare)
117 Tradepark Dr
Suite B
Somerset, KY 42503-3428
Phone (606) 679-2773
4101 Charlotte Ave
Suite F185
Nashville, TN 37209-4066
4308 Brainerd Rd
Chattanooga, TN 37411-5424
Phone (423) 698-1966
7348 E Brainerd Rd
Chattanooga, TN 37421-3842
Phone (205) 822-8038
9600 Two Notch Rd
Suite 5
Columbia, SC 29223-1612
Phone (407) 219-5402
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in KY, TN, SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171107002069 | KY | Practitioner - Nurse Practitioner | 7719243781 | Reassigns benefits to 8 organizations |
| I20251111000966 | TN | Practitioner - Nurse Practitioner | 7719243781 | Reassigns benefits to 4 organizations |
| I20260422000884 | SC | Practitioner - Nurse Practitioner | 7719243781 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39969 | TN | MD | Ambulatory Care Pharmacist |
| 3011787 | KY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| VMD Primary Providers Central Kentucky | Current |
Accepting new patients | |
| Pinelake Physician Practice LLC | Family | Current |
Accepting new patients |
| VMD Primary Providers Central Kentucky | Current |
Accepting new patients | |
| Pinelake Physician Practice, LLC | Current |
Accepting new patients | |
| Pinelake Physician Practice, LLC | Current | Accepting new patients | |
| Primary Care Medical Center Inc | Family | Current | Accepting new patients |
| Upperline Healthcare, PC | Current |
Accepting new patients | |
| Fast Pace Kentucky PLLC | Family | Current |
Accepting new patients |
| Advanced Foot Care LLP | Current |
Accepting new patients | |
| Cumberland Foot & Ankle Centers | Family | Current | Accepting new patients |
| Fast Pace Kentucky, PLLC | Current |
Accepting new patients | |
| Upperline Healthcare, PC | Current |
Accepting new patients | |
| Advanced Foot Care, LLP | Current |
Accepting new patients | |
| Cumberland Foot and Ankle Centers | Current |
Accepting new patients | |
| Vital Path Care PC | Current |
Accepting new patients | |
| Cumberland Foot and Ankle Center | Current |
Accepting new patients |
Locations
7545 Alexandria Pike
Alexandria, KY 41001
Phone (859) 365-5856
796 W Broadway St
Campbellsville, KY 42718
Phone (270) 572-4933
106 W Clay St
Clinton, KY 42031
Phone (270) 653-0220
308 S Washington St
Ste 200
Clinton, KY 42031
Phone (270) 653-0220
1475 Nashville Rd
Franklin, KY 42134
Phone (270) 813-1111
1251 Paris Rd
Mayfield, KY 42066
Phone (270) 356-1345
1029 Medical Center Cir
Ste 401
Mayfield, KY 42066
Phone (270) 251-4590
1000 S 12th St
Murray, KY 42071
Phone (270) 759-9200
340 Highway 44 E
Shepherdsville, KY 40165
Phone (502) 215-8422
117 Tradepark Dr
Ste B
Somerset, KY 42503
Phone (606) 679-2773
115 Tradepark Dr
Ste A
Somerset, KY 42503
Phone (606) 678-5708
9600 Two Notch Rd
Ste 5
Columbia, SC 29223
Phone (239) 652-0260
330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780
1720 Gunbarrel Rd
Ste 204
Chattanooga, TN 37421
Phone (423) 533-8556
7348 E Brainerd Rd
Chattanooga, TN 37421
Phone (205) 822-8038
4308 Brainerd Rd
Chattanooga, TN 37411
Phone (423) 698-1966
Interoperability endpoints
- stephannie.goodrum.1@4399.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 3011787 | KY | Yes |
Addresses
Primary practice location
308 S Washington St Ste 200
Clinton, KY 42031-1347
Mailing address
175 Evans LN
Clinton, KY 42031-9402
Phone (270) 217-9558
Other providers in Clinton, KY
- Clinton Pharmacy LLC
- Clinton-Hickman County Ambulance Service Inc
- Communtiy Healthcare of Western Kentucky LLC
- Diversicare Clinton, LLC
- Giaimo Mobile Podiatry PLLC
- Whitney Nicole Gordon
- Gretchen Anne Hayden
- Hickman County Board of Education
- Hickman County High School Clinic
- Hospital of Fulton Inc
All providers in Clinton, KY · Family Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 7, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.