=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821707936
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN GOODEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2022
-----------------------------------------------------
Last Update Date | 11/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 379 6TH AVE W
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34205-8820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-782-4150
-----------------------------------------------------
Fax | 941-782-4301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 197515
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37219-7515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-782-4299
-----------------------------------------------------
Fax | 941-782-4301
-----------------------------------------------------
=====================================================
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 | APRN11022311
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------