Provider Demographics
NPI:1235893439
Name:GOODE, COURTNEY PAIGE (CNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:PAIGE
Last Name:GOODE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 SUGAR RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-4181
Mailing Address - Country:US
Mailing Address - Phone:937-986-8282
Mailing Address - Fax:
Practice Address - Street 1:4200 REGENT ST STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6229
Practice Address - Country:US
Practice Address - Phone:937-641-3600
Practice Address - Fax:614-968-8440
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHARPN.CNP.0028284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0005079Medicaid