Provider Demographics
NPI:1871907865
Name:GOODE, KEELEE (MT)
Entity type:Individual
Prefix:
First Name:KEELEE
Middle Name:
Last Name:GOODE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 JANE DR
Mailing Address - Street 2:
Mailing Address - City:CULLODEN
Mailing Address - State:WV
Mailing Address - Zip Code:25510-9512
Mailing Address - Country:US
Mailing Address - Phone:304-546-6804
Mailing Address - Fax:
Practice Address - Street 1:1027 JANE DR
Practice Address - Street 2:
Practice Address - City:CULLODEN
Practice Address - State:WV
Practice Address - Zip Code:25510-9512
Practice Address - Country:US
Practice Address - Phone:304-546-6804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2005-1660174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist