Provider Demographics
NPI:1801820097
Name:GOODNER, ASHA LYN (FNP)
Entity type:Individual
Prefix:MS
First Name:ASHA
Middle Name:LYN
Last Name:GOODNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412057
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2057
Mailing Address - Country:US
Mailing Address - Phone:314-747-5900
Mailing Address - Fax:314-747-5936
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 5A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-5900
Practice Address - Fax:314-747-5936
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024020449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000530401OtherANTHEM
OH000000362395OtherANTHEM
OHP00222435OtherRAILROAD MEDICARE
OH2553795Medicaid
OH7785667OtherAETNA
OHGONP09226Medicare Oscar/Certification
OHP45863Medicare UPIN
OH7785667OtherAETNA