Provider Demographics
NPI:1235647728
Name:GOODMAN, CAROLYN DAWN (NP-C)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DAWN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:DAWN
Other - Last Name:TRIVETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 E HILL AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37915-2565
Mailing Address - Country:US
Mailing Address - Phone:865-862-0998
Mailing Address - Fax:831-755-1702
Practice Address - Street 1:1301 SUNSET DR STE 3
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-7906
Practice Address - Country:US
Practice Address - Phone:423-588-7130
Practice Address - Fax:423-588-7128
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF95008234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily