Provider Demographics
NPI:1659468544
Name:GOLDMAN, NANCY HOPE (APRN, BC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:HOPE
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 OLD CANTON RD
Mailing Address - Street 2:SUITE 465
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4200
Mailing Address - Country:US
Mailing Address - Phone:601-899-2885
Mailing Address - Fax:
Practice Address - Street 1:3000 OLD CANTON RD
Practice Address - Street 2:SUITE 465
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4200
Practice Address - Country:US
Practice Address - Phone:601-899-2885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR624144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS890000010Medicare ID - Type Unspecified