Provider Demographics
NPI:1528069531
Name:GOLDSON, MISTY R (PMHNP, FNP)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:R
Last Name:GOLDSON
Suffix:
Gender:F
Credentials:PMHNP, FNP
Other - Prefix:MISS
Other - First Name:MISTY
Other - Middle Name:R
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP, FNP
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:BURNSIDE
Mailing Address - State:KY
Mailing Address - Zip Code:42519-0142
Mailing Address - Country:US
Mailing Address - Phone:606-400-2227
Mailing Address - Fax:606-332-0576
Practice Address - Street 1:600 MONTICELLO ST STE 1
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2974
Practice Address - Country:US
Practice Address - Phone:606-400-2227
Practice Address - Fax:606-332-0576
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004253363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK197601Medicare PIN
TNP99413Medicare UPIN
KYK197600Medicare PIN
TN103I500188Medicare PIN