Provider Demographics
NPI:1295150787
Name:GOULDER, REGINA (FNP-C)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:GOULDER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:76 CAPITAL WAY
Practice Address - Street 2:SUITE C
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-6832
Practice Address - Country:US
Practice Address - Phone:901-840-1202
Practice Address - Fax:901-840-1204
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily