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General NPI Number Information
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NPI Number | 1679152821
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Entity Type | Individual
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Provider Name | LAUREN T GOODALE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 1013 W UNIVERSITY AVE
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City | GEORGETOWN
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State | TX
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Zip | 78628-5340
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Country | US
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Telephone | 512-359-8349
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Fax |
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Provider Business Mailing Address
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Address Line | 251 CACTUS SPUR
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City | KILLEEN
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State | TX
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Zip | 76542-5019
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Country | US
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Telephone | 254-290-9297
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1027215
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License Number State | TX
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