Provider Demographics
NPI:1134425705
Name:GOODNIGHT, GRETCHEN LAUREL (ANP)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LAUREL
Last Name:GOODNIGHT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 MORROW ST N STE D
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-4324
Mailing Address - Country:US
Mailing Address - Phone:479-437-6080
Mailing Address - Fax:479-437-6079
Practice Address - Street 1:403 MORROW ST N STE D
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4324
Practice Address - Country:US
Practice Address - Phone:479-437-6080
Practice Address - Fax:479-437-6079
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR195568758Medicaid
AR2I7543OtherMEDICARE