Provider Demographics
NPI:1952776890
Name:GOEDECKE, AMY LEE (RN,MSN,FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LEE
Last Name:GOEDECKE
Suffix:
Gender:F
Credentials:RN,MSN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76273-1805
Mailing Address - Country:US
Mailing Address - Phone:903-564-7709
Mailing Address - Fax:903-564-7090
Practice Address - Street 1:401 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:TX
Practice Address - Zip Code:76273-1805
Practice Address - Country:US
Practice Address - Phone:903-564-7709
Practice Address - Fax:903-564-7090
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129412363LF0000X
OK87252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily