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General NPI Number Information
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NPI Number | 1457201469
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Entity Type | Individual
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Provider Name | JACKIE GOODEN LPN
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Gender | Female
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Dates
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Enumeration Date | 01/29/2026
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 215 W LOCUST ST
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City | STANFIELD
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State | OR
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Zip | 97875-9704
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Country | US
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Telephone | 541-969-2264
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Fax |
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Provider Business Mailing Address
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Address Line | 890 W ORCHARD AVE
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City | HERMISTON
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State | OR
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Zip | 97838-1569
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Country | US
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Telephone | 541-969-2264
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 201330204LPN
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License Number State | OR
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