Provider Demographics
NPI:1801563010
Name:GOLDY, KAREN LYNNE (AGAC-NP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LYNNE
Last Name:GOLDY
Suffix:
Gender:F
Credentials:AGAC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2062 POST DR NE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-8864
Mailing Address - Country:US
Mailing Address - Phone:616-990-4356
Mailing Address - Fax:
Practice Address - Street 1:950 CORPORATE OFFICE DR STE 150
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-5004
Practice Address - Country:US
Practice Address - Phone:800-893-5493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704267027363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care