Provider Demographics
NPI:1073280111
Name:GOODALE, VALERIE (FNP-BC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:GOODALE
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 WISCONSIN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4073
Mailing Address - Country:US
Mailing Address - Phone:507-512-0350
Mailing Address - Fax:
Practice Address - Street 1:3230 WISCONSIN AVE STE A
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4073
Practice Address - Country:US
Practice Address - Phone:417-347-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024025462363LP0808X
MO2021033947363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health