MR. KIM DALE GOODRUM R.N. NPI 1558520114

NPI Information

NPI: 1558520114
Provider Name: MR. KIM DALE GOODRUM, R.N.
Classification: Registered Nurse - 163WP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

Address:
825 PALMILLA DR
MODESTO, CA
ZIP 95356
Phone: (209) 572-3243
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MR. Kim Dale Goodrum, R.N. is a psychiatric/mental health registered nurse in Modesto, CA. MR. Kim Dale Goodrum, R.N. NPI is 1558520114. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

825 PALMILLA DR
MODESTO, CA
ZIP 95356-152
Phone: (209) 572-3243

The enumeration date for this NPI number is 6/8/2008 and was last updated on 6/8/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163WP0808X	Registered Nurse	Psychiatric/Mental Health	696742	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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