Healthcare Provider Details

I. General information

NPI: 1982910758
Provider Name (Legal Business Name): KIM E GOLDINGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W MADISON ST
PULASKI TN
38478-2611
US

IV. Provider business mailing address

625 W MADISON ST
PULASKI TN
38478-2611
US

V. Phone/Fax

Practice location:
  • Phone: 931-424-7389
  • Fax: 931-363-9891
Mailing address:
  • Phone: 931-424-7389
  • Fax: 931-363-9891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000015109
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: