Provider Demographics
NPI:1447016589
Name:GOODIN, SALLY H (NP)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:H
Last Name:GOODIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:LANDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7992 COBBLESPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8786
Mailing Address - Country:US
Mailing Address - Phone:317-294-5646
Mailing Address - Fax:
Practice Address - Street 1:714 N SENATE AVE STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3297
Practice Address - Country:US
Practice Address - Phone:317-944-4831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014990A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily