Provider Demographics
NPI:1053299628
Name:JACKSON-GOODRIDGE, KEITA ZAKIYA (APRN CNM)
Entity type:Individual
Prefix:
First Name:KEITA
Middle Name:ZAKIYA
Last Name:JACKSON-GOODRIDGE
Suffix:
Gender:F
Credentials:APRN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 CHATHAM RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5409
Mailing Address - Country:US
Mailing Address - Phone:443-452-7930
Mailing Address - Fax:
Practice Address - Street 1:2 JENNIFER CT
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7694
Practice Address - Country:US
Practice Address - Phone:443-452-7930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife