Individual
NICOLE M GOOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1701 N SENATE AVE, INDIANAPOLIS, IN 46202-5306
(317) 962-8776
Mailing address
1701 N SENATE AVE, INDIANAPOLIS, IN 46202-5306
(317) 962-8776
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28190683A
IN
363LF0000X
Family Nurse Practitioner
Primary
71014819A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103830360
ANTHEM PTAN
IN
05
—
300086862
—
IN
Enumeration date
02/06/2024
Last updated
06/17/2025
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