Provider Demographics
NPI:1255875811
Name:GOLDBERG, JAMIE BETH (ACNP/PMHNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:BETH
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:ACNP/PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2000
Mailing Address - Country:US
Mailing Address - Phone:406-498-5449
Mailing Address - Fax:
Practice Address - Street 1:1083 W PARK AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2000
Practice Address - Country:US
Practice Address - Phone:406-498-5449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT116142363LA2100X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care