Provider Demographics
NPI:1053910794
Name:GOODSON, TIMIKA SHANTE (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TIMIKA
Middle Name:SHANTE
Last Name:GOODSON
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:TIMIKA
Other - Middle Name:SHANTE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 GENTLE BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2549
Mailing Address - Country:US
Mailing Address - Phone:443-529-2027
Mailing Address - Fax:
Practice Address - Street 1:3421 GENTLE BREEZE DR # A
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2549
Practice Address - Country:US
Practice Address - Phone:443-529-2027
Practice Address - Fax:240-306-9503
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1055089363LF0000X, 363LP0808X, 163WC1500X
MDR228537363LP0808X, 363LF0000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health