Healthcare Provider Details

I. General information

NPI: 1528069531
Provider Name (Legal Business Name): MISTY R GOLDSON PMHNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY R DECKER PMHNP, FNP

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 02/22/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MONTICELLO ST STE 1
SOMERSET KY
42501-2974
US

IV. Provider business mailing address

PO BOX 142
BURNSIDE KY
42519-0142
US

V. Phone/Fax

Practice location:
  • Phone: 606-400-2227
  • Fax: 606-332-0576
Mailing address:
  • Phone: 606-400-2227
  • Fax: 606-332-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3004253
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3004253
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: