=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487039996
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETTY ANN GOULD APRN, FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2015
-----------------------------------------------------
Last Update Date | 09/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HC 65 BOX 164
-----------------------------------------------------
City | KANARRAVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84742-6502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-931-0063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 65 BOX 164
-----------------------------------------------------
City | KANARRAVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84742-6502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-931-0063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 5158098-3102
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 318108
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN63613
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN63613
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5158098-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------