Healthcare Provider Details

I. General information

NPI: 1508859984
Provider Name (Legal Business Name): COLLEEN KING GOODE DNP, MA, FNP-BC, CNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COLLEEN ANN KING

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 S MAIN CHAPEL WAY STE 104
GAMBRILLS MD
21054-1860
US

IV. Provider business mailing address

2947 ROBIN RD
YORK PA
17404-5769
US

V. Phone/Fax

Practice location:
  • Phone: 443-814-9108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR201512
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR201512
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: