Healthcare Provider Details

I. General information

NPI: 1275313082
Provider Name (Legal Business Name): MONIQUE GOODEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONIQUE BURTON

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 E COUNTY LINE RD STE 6
RIDGELAND MS
39157-1937
US

IV. Provider business mailing address

1060 E COUNTY LINE RD STE 6
RIDGELAND MS
39157-1937
US

V. Phone/Fax

Practice location:
  • Phone: 601-357-0669
  • Fax:
Mailing address:
  • Phone: 601-438-2678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906291
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: