Provider Demographics
NPI:1124773254
Name:DAVIDSON, BARBARA GOODGION (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:GOODGION
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 BLUE HERON RD
Mailing Address - Street 2:
Mailing Address - City:DUBACH
Mailing Address - State:LA
Mailing Address - Zip Code:71235-3429
Mailing Address - Country:US
Mailing Address - Phone:318-235-3294
Mailing Address - Fax:
Practice Address - Street 1:3100 KILPATRICK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5156
Practice Address - Country:US
Practice Address - Phone:318-325-8050
Practice Address - Fax:318-325-5385
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA224138363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health