Provider Demographics
NPI:1174842447
Name:GOFORTH, KATRINA JO (BS)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:JO
Last Name:GOFORTH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3206 S 117TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-1931
Mailing Address - Country:US
Mailing Address - Phone:918-408-4671
Mailing Address - Fax:918-832-8775
Practice Address - Street 1:RR 1 BOX 131C
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-9223
Practice Address - Country:US
Practice Address - Phone:918-452-3133
Practice Address - Fax:918-452-3939
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator