Provider Demographics
NPI:1144043936
Name:GOODMAN, HUNTER (APRN, CNP)
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W VANDAMENT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4665
Mailing Address - Country:US
Mailing Address - Phone:405-350-8100
Mailing Address - Fax:
Practice Address - Street 1:508 W VANDAMENT AVE STE 100
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4665
Practice Address - Country:US
Practice Address - Phone:405-350-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK220566363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health