Individual provider Active NPI

Laura Lee Goethe, FNP-BC

  • Family Nurse Practitioner
  • Sierra Vista, AZ
National Provider Identifier
1649575580
Registry record updated Feb 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP3927 Issued in AZ
Practice address
1620 E Wilcox Dr
Sierra Vista, AZ 85635-2778
Phone
(520) 459-0362
Fax
(520) 458-1585
NPI assigned
Jan 25, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP3927 AZ Primary

Addresses

Primary practice location

1620 E Wilcox Dr
Sierra Vista, AZ 85635-2778

Mailing address

1620 E Wilcox Dr
Sierra Vista, AZ 85635-2778
Phone (520) 459-0362

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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 1

Enrollment IDStateProvider typePAC IDDetails
I20110329000774 AZ Practitioner - Nurse Practitioner 9436332426 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carnett Clinic, LLC CurrentSince Feb 2, 2013 Accepting new patients

Locations

4990 E Mediterranean Dr
Ste A
Sierra Vista, AZ 85635
Phone (520) 439-5186

4990 E Mediterranean Dr
Sierra Vista, AZ 85635
Phone (520) 417-1163

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1295913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297209600000",
    "number": "1649575580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 E WILCOX DR",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352778",
            "telephone_number": "520-459-0362",
            "fax_number": "520-458-1585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 E WILCOX DR",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352778",
            "telephone_number": "520-459-0362",
            "fax_number": "520-458-1585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOETHE",
        "first_name": "LAURA",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-25",
        "last_updated": "2011-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP3927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sierra Vista, AZ

Sources for this page

Verify at the official NPI Registry.