Individual
MRS. MIRANDA LEE GOFORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
146 PASSION PLAY RD STE A, EUREKA SPRINGS, AR 72632-9455
(479) 253-9746
Mailing address
146 PASSION PLAY RD STE A, EUREKA SPRINGS, AR 72632-9455
(479) 253-9746
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R874514
AR
363LF0000X
Family Nurse Practitioner
15025
TN
363LF0000X
Family Nurse Practitioner
Primary
218923
AR
Other
Enumeration date
06/07/2010
Last updated
06/17/2022
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