Provider Demographics
NPI:1114946449
Name:GOFF, KENNETH WAYNE (APN)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:WAYNE
Last Name:GOFF
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 JONES RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0875
Mailing Address - Country:US
Mailing Address - Phone:479-306-4957
Mailing Address - Fax:479-750-6622
Practice Address - Street 1:901 JONES RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0875
Practice Address - Country:US
Practice Address - Phone:479-306-4957
Practice Address - Fax:479-750-6622
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01752363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care