=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124773254
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA GOODGION DAVIDSON APRN, PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2022
-----------------------------------------------------
Last Update Date | 02/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3100 KILPATRICK BLVD STE 100
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71201-5156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-325-8050
-----------------------------------------------------
Fax | 318-325-5385
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 295 BLUE HERON RD
-----------------------------------------------------
City | DUBACH
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71235-3429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-235-3294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 224138
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------