Individual
KILEY NICOLE GOODEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
210 ASHVILLE AVE, CARY, NC 27518-6676
(919) 350-7331
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-0351
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-12095
NC
363AS0400X
Surgical Physician Assistant
Primary
0010-12095
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760059661
—
NC
Enumeration date
06/08/2021
Last updated
10/31/2023
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