Stephannie Goodrum (NPI# 1700396405, PAC ID# 7719243781) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1700396405 |
| PAC ID by PECOS | 7719243781 |
| Professional Enrollment ID | I20171107002069 |
| Full Name | Stephannie Goodrum |
| Organization Legal Name | PINELAKE PHYSICIAN PRACTICE LLC |
| Address |
106 W Clay St Clinton KY 42031-1317 |
| Phone Number | 2706530220 |
| Gender | F |
| Medical School | A T STILL UN, ARIZONA SCHL OF DENT.Y & ORAL HLTH |
| Graduation Year | 2017 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 6800797507 |
| Number of Group Practice Members | 32 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 180116 | JACKSON PURCHASE MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 106 W Clay St, Clinton, KY 42031-1317 | 2706530220 | PINELAKE PHYSICIAN PRACTICE LLC |
| Organization Legal Name | PINELAKE PHYSICIAN PRACTICE LLC |
| Physicians | 33 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amy M Turner | Nurse Practitioner | Pinelake Physician Practice LLC | 106 W Clay St, Clinton, KY 42031-1317 |
| Sarah M Darnell | Nurse Practitioner | Pinelake Physician Practice LLC | 1029 Medical Ctr Cir, Mayfield, KY 42066-1189 |
| Lela Cole | Nurse Practitioner | Pinelake Physician Practice LLC | 110 S 9th St, Mayfield, KY 42066-2208 |
| Tyrone Lee Daniels | Cardiovascular Disease (cardiology) | Pinelake Physician Practice LLC | 1111 Medical Ctr Cir, Mayfield, KY 42066-1194 |
| Tanna S Vaughan | Nurse Practitioner | Pinelake Physician Practice LLC | 1029 Medical Ctr Cir, Mayfield, KY 42066-1189 |
| Jessica Little | Podiatry | Pinelake Physician Practice LLC | 1029 Medical Ctr Cir, Suite 401, Mayfield, KY 42066-1189 |
| Elias Pitaras | Nephrology | Pinelake Physician Practice LLC | 1111 Medical Ctr Cir, Mayfield, KY 42066-1194 |
| Melisha Danielle Baldwin | Obstetrics/gynecology | Pinelake Physician Practice LLC | 1029 Medical Ctr Cir, Mayfield, KY 42066-1189 |
| Jonathan A Wynstra | Obstetrics/gynecology | Pinelake Physician Practice LLC | 1111 Medical Ctr Cir, Mayfield, KY 42066-1194 |
| Wayne E Williams | Family Medicine | Pinelake Physician Practice LLC | 1029 Medical Ctr Cir, Mayfield, KY 42066-1189 |
| Street Address |
106 W CLAY ST |
| City | CLINTON |
| State | KY |
| Zip | 42031-1317 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Amy M Turner | Nurse Practitioner | Pinelake Physician Practice LLC | 106 W Clay St, Clinton, KY 42031-1317 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Leslie Ann Acosta | Nurse Practitioner | Medoptions of Kentucky LLC | 106 Padgett Dr, Clinton, KY 42031-1313 |
| Bruce C Smith | Family Practice | 308 S Washington St, Clinton, KY 42031-1347 |
| City | CLINTON |
| Zip Code | 42031 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | CLINTON + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Stephannie Goodrum.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.