Healthcare Provider Details

I. General information

NPI: 1952185076
Provider Name (Legal Business Name): RILEY KAE GOUDIE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RILEY KAE OBERHOLTZER NP

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 N 3RD ST STE 300
PHOENIX AZ
85020-2466
US

IV. Provider business mailing address

9225 N 3RD ST STE 300
PHOENIX AZ
85020-2466
US

V. Phone/Fax

Practice location:
  • Phone: 602-445-0751
  • Fax:
Mailing address:
  • Phone: 602-445-0751
  • Fax: 602-424-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number238479
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number238479
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number238479
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: