Timika Shante Goodson, FNP-C, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R228537 Issued in MD

Practice address

3421 Gentle Breeze Dr # a
Upper Marlboro, MD 20772-2549

Phone

(443) 529-2027

Fax

(240) 306-9503

NPI assigned

Oct 23, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Other names 1

• Timika Shante Fisher Former name

Medicare fee-for-service enrollment

Enrolled in DC, MD2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marissa Block LLC

  • Professional Counselor
  • Towson, MD
  • NPI 1407453939
  Medicare reassignment NPD
• Neighborhood Nurse

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Upper Marlboro, MD
  • NPI 1609594704
  NPD
• Marissa Block LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Towson, MD
  • NPI 1982380440
  NPD (past)
• Neighborhood Nurse, LLC

  • Home Health Agency
  • Upper Marlboro, MD
  • NPI 1447978457
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1053910794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 GENTLE BREEZE DR",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207722549",
            "telephone_number": "443-529-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3421 GENTLE BREEZE DR # A",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207722549",
            "telephone_number": "443-529-2027",
            "fax_number": "240-306-9503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODSON",
        "first_name": "TIMIKA",
        "middle_name": "SHANTE",
        "credential": "FNP-C, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-23",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "DC",
            "license": "RN1055089",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "DC",
            "license": "RN1055089",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R228537",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R228537",
            "primary": false
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "DC",
            "license": "RN1055089",
            "primary": false
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "MD",
            "license": "R228537",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIMIKA",
            "last_name": "FISHER",
            "middle_name": "SHANTE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristy Teresa Godwin, LCPC
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• Golden Sunset Services, Inc.
• Golden Warmth Behavioral Health
• Jamaal Devane Gooding
• Goodwill Medical Supplies LLC
• Gosheni LLC
• April Goss
• Wanda Yyonnette Govan-Jenkins, DNP, MBA, MS, RN
• Grace Line Nursing LLC

• Psychiatric/Mental Health Nurse Practitioner in Upper Marlboro, MD
• Providers in Upper Marlboro, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.