Provider Demographics
NPI:1356680573
Name:GOODE, COURTNEY DANIELLE (NP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DANIELLE
Last Name:GOODE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 342322
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38184-2322
Mailing Address - Country:US
Mailing Address - Phone:901-230-2269
Mailing Address - Fax:502-568-7136
Practice Address - Street 1:1630 GOODMAN RD E STE 3
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9556
Practice Address - Country:US
Practice Address - Phone:901-821-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA810522363L00000X
TN17234363LF0000X
TNAPN0000017234363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS810522OtherBOARD OF NURSING