Provider Demographics
NPI:1194752790
Name:GOODALE, KAREN L (PA)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:L
Last Name:GOODALE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 NC 108 HWY E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-7721
Mailing Address - Country:US
Mailing Address - Phone:828-894-3494
Mailing Address - Fax:828-894-5864
Practice Address - Street 1:2881 NC HWY 108 E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722-7721
Practice Address - Country:US
Practice Address - Phone:828-894-3494
Practice Address - Fax:828-894-5864
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05347363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP305033617Medicare PIN
SCP30503Medicare UPIN
SC0490PAMedicaid