Provider Demographics
NPI:1144835331
Name:GOODELL, HOLLY ANINE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANINE
Last Name:GOODELL
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANINE
Other - Last Name:GREGG, CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3919 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2307
Mailing Address - Country:US
Mailing Address - Phone:970-580-0723
Mailing Address - Fax:
Practice Address - Street 1:416 W 48TH ST STE 28
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-1314
Practice Address - Country:US
Practice Address - Phone:308-708-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE113169OtherAPRN-NURSE PRACTITIONER