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Individual

DEDRA C GOFF

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-BC

Contact information

Practice address
9669 E 146TH ST STE 250, NOBLESVILLE, IN 46060-5006
(317) 621-5719
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7561

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2014014914
WV
363LF0000X
Family Nurse Practitioner
Primary
71008322A
IN
363LF0000X
Family Nurse Practitioner
COA.16884-NP
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0109921
OH
05
3810027996
WV
01
P01529305
RAILROAD MEDICARE
OH
Enumeration date
08/05/2014
Last updated
06/18/2021
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