1578312559 NPI number — MS. MELISSA L GOOD STATE CERTIFIED BIRT

Table of content: MS. MELISSA L GOOD STATE CERTIFIED BIRT (NPI 1578312559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578312559 NPI number — MS. MELISSA L GOOD STATE CERTIFIED BIRT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOOD
Provider First Name:
MELISSA
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
STATE CERTIFIED BIRT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BIGGS
Provider Other First Name:
MELISSA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578312559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10251 RIDGELINE DRIVE
Provider Second Line Business Mailing Address:
#A348
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-438-0787
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10251 RIDGELINE DRIVE
Provider Second Line Business Practice Location Address:
#A348
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-438-0787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374J00000X , with the licence number:  BD61553742 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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