Provider Demographics
NPI:1538814348
Name:GOODRIDGE, COLE FREDERICK (MSN)
Entity type:Individual
Prefix:MR
First Name:COLE
Middle Name:FREDERICK
Last Name:GOODRIDGE
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 COLINA DR
Mailing Address - Street 2:
Mailing Address - City:VILLA HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3741
Mailing Address - Country:US
Mailing Address - Phone:859-620-4914
Mailing Address - Fax:
Practice Address - Street 1:1064 COLINA DR
Practice Address - Street 2:
Practice Address - City:VILLA HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3741
Practice Address - Country:US
Practice Address - Phone:859-620-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ269855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily