Provider Demographics
NPI:1831492610
Name:GOODSON, BECKY
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:GOODSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 S GILBERT RD
Mailing Address - Street 2:STE 111
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-5892
Mailing Address - Country:US
Mailing Address - Phone:480-398-1220
Mailing Address - Fax:480-983-4317
Practice Address - Street 1:1111 S STAPLEY DR STE 111
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5060
Practice Address - Country:US
Practice Address - Phone:480-398-1220
Practice Address - Fax:480-398-1230
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN137766163W00000X
AZAP3868363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse