Provider Demographics
NPI:1700238433
Name:GOEN, DAVID R (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:GOEN
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 E DISTRICT ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85714-2081
Mailing Address - Country:US
Mailing Address - Phone:520-301-2400
Mailing Address - Fax:
Practice Address - Street 1:2802 E DISTRICT ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-2081
Practice Address - Country:US
Practice Address - Phone:520-301-2400
Practice Address - Fax:520-296-9556
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2024-02-07
Deactivation Date:2018-09-13
Deactivation Code:
Reactivation Date:2018-09-25
Provider Licenses
StateLicense IDTaxonomies
AZAP10640363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ003627Medicaid
AZ531582YMP3OtherMEDICAID