Healthcare Provider Details

I. General information

NPI: 1194752790
Provider Name (Legal Business Name): KAREN L GOODALE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 NC HWY 108 E
COLUMBUS NC
28722-7721
US

IV. Provider business mailing address

2881 NC 108 HWY E
COLUMBUS NC
28722-7721
US

V. Phone/Fax

Practice location:
  • Phone: 828-894-3494
  • Fax: 828-894-5864
Mailing address:
  • Phone: 828-894-3494
  • Fax: 828-894-5864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-05347
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: