Provider Demographics
NPI:1669562724
Name:GODDARD, DOROTHY DENISE (FNP MSN RN)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:DENISE
Last Name:GODDARD
Suffix:
Gender:F
Credentials:FNP MSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 CENTRAL PKWY E STE 275
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5542
Mailing Address - Country:US
Mailing Address - Phone:728-814-6889
Mailing Address - Fax:972-372-1657
Practice Address - Street 1:850 CENTRAL PKWY E STE 275
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074
Practice Address - Country:US
Practice Address - Phone:972-881-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX500013363LF0000X
TXAP115315363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184990303Medicaid
TX500013OtherNURSING LICENSE
TX8Y3816OtherBLUE CROSS
TX8Y3816OtherBLUE CROSS
TX184990303Medicaid