Shaneika Gouldbourne, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2026025306 Issued in MO

Practice address

1511 Christy Dr
Jefferson City, MO 65101-2854

Phone

(573) 632-2777

NPI assigned

Jun 11, 2026

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1781136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781136000000",
    "number": "1629902937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 NW 18TH CT",
            "city": "LAUDERHILL",
            "state": "FL",
            "postal_code": "333134125",
            "telephone_number": "954-982-3733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 CHRISTY DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651012854",
            "telephone_number": "573-632-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOULDBOURNE",
        "first_name": "SHANEIKA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-06-11",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2026025306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kierstyn Thea Gillooly, PHARM.D.
• Ashley Marie Ginter, PSY.D.
• Brandy Nicole Glascock, M.D.
• Mitchell Teruichi Godbee, MD
• Kimberly Goff, PTA
• Justin Gourley, PHARM.D
• Brandi Govero, LPC
• Grace Behavioral Health LLC
• Grace Counseling Center, LLC
• Amber Graham

• General Practice Dentistry in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.