Provider Demographics
NPI:1730343377
Name:JONES GOODWIN, MARY KATHERYN (MSN, APN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERYN
Last Name:JONES GOODWIN
Suffix:
Gender:F
Credentials:MSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:157 WEST CHURCH ST
Mailing Address - Street 2:PO BOX 185
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351
Mailing Address - Country:US
Mailing Address - Phone:731-968-8182
Mailing Address - Fax:731-968-8185
Practice Address - Street 1:157 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-2011
Practice Address - Country:US
Practice Address - Phone:731-968-8182
Practice Address - Fax:731-968-8185
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN13401363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics