Basic Information
| Provider Information | |||||||||
| NPI: | 1124773254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIDSON | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | GOODGION | ||||||||
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| Credential: | APRN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 295 BLUE HERON RD | ||||||||
| Address2: | |||||||||
| City: | DUBACH | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712353429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182353294 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3100 KILPATRICK BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712015156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183258050 | ||||||||
| FaxNumber: | 3183255385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2022 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 224138 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.