Individual provider · Type 1 NPI

Nicole Goodman, ATC, LAT

Student in an Organized Health Care Education/Training Program · Tyler, TX

NPI number 1609224393 Active

Practice location

13172 State Highway 64 E
Tyler, TX 75707-5340

Call (502) 542-0583 Map

Mailing address

5613 Oakmeadow Dr, Apt 906
Fort Worth, TX 76132-2469

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XAT6334 (TX)

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1609224393

Nicole Goodman, ATC, LAT's National Provider Identifier is 1609224393, issued on Jun 2, 2016. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Tyler, TX. The record was last updated on Jun 2, 2016.