Provider Demographics
NPI:1306407101
Name:GOFF-YATES, AMY L (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:GOFF-YATES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 SPRINGBORO W STE 201
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-297-8999
Mailing Address - Fax:
Practice Address - Street 1:2320 BEECHWOOD DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:OH
Practice Address - Zip Code:45327-9462
Practice Address - Country:US
Practice Address - Phone:937-895-4092
Practice Address - Fax:937-855-6044
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNP024867363LF0000X
OHAPRN.CNP.024867363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily