Provider Demographics
NPI:1326006768
Name:GOOLSBY, RAMONA LYNN (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:RAMONA
Middle Name:LYNN
Last Name:GOOLSBY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:MRS
Other - First Name:RAMONA
Other - Middle Name:LYNN
Other - Last Name:CLAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:601 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-3319
Mailing Address - Country:US
Mailing Address - Phone:580-286-6688
Mailing Address - Fax:580-286-6699
Practice Address - Street 1:601 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-3319
Practice Address - Country:US
Practice Address - Phone:580-286-6699
Practice Address - Fax:580-286-6699
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0058803363LF0000X
TX594059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200086610-AMedicaid
Q69126Medicare PIN