Provider Demographics
NPI:1598272528
Name:GOODE, GABRIELLE (APRN)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:GOODE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E GRAY ST STE 803
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3904
Mailing Address - Country:US
Mailing Address - Phone:502-523-6389
Mailing Address - Fax:
Practice Address - Street 1:210 E GRAY ST STE 803
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3904
Practice Address - Country:US
Practice Address - Phone:502-238-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011864363LF0000X
KY1130433163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice