Provider Demographics
NPI:1619074739
Name:GOODEN, ALEXA J (PHD, RN, BC, CNS)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:J
Last Name:GOODEN
Suffix:
Gender:F
Credentials:PHD, RN, BC, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6262 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4055
Mailing Address - Country:US
Mailing Address - Phone:918-492-8200
Mailing Address - Fax:918-493-3268
Practice Address - Street 1:6125 S SHERIDAN RD
Practice Address - Street 2:SUITE D
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4056
Practice Address - Country:US
Practice Address - Phone:918-585-3083
Practice Address - Fax:918-492-2075
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK32152363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner