Organization
GOODE PROVIDER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COURTNEY GOODE (OWNER)
(662) 470-7232
Entity
Organization
Contact information
Practice address
1630 GOODMAN RD E STE 3, SOUTHAVEN, MS 38671-9556
(662) 470-7232
Mailing address
PO BOX 342322, BARTLETT, TN 38184-2322
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q102274
—
TN
Enumeration date
04/21/2025
Last updated
06/11/2025
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