Provider Demographics
NPI:1194920397
Name:GOODSPEED, KARA MAURENE (MSN, FNP)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:MAURENE
Last Name:GOODSPEED
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1676
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-8676
Mailing Address - Country:US
Mailing Address - Phone:210-827-1218
Mailing Address - Fax:
Practice Address - Street 1:372 HILLL ROAD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TX
Practice Address - Zip Code:78957
Practice Address - Country:US
Practice Address - Phone:210-827-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX621906363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185831801Medicaid
TX185831802OtherCSHCN
TX185831801Medicaid