Provider Demographics
NPI:1386834273
Name:GOFF, SHIRLEY H (APRN)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:H
Last Name:GOFF
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1433
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-1433
Mailing Address - Country:US
Mailing Address - Phone:606-218-6011
Mailing Address - Fax:606-218-6082
Practice Address - Street 1:50 WEDDINGTON BRANCH RD
Practice Address - Street 2:SUITE C
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3296
Practice Address - Country:US
Practice Address - Phone:606-218-6011
Practice Address - Fax:606-218-6082
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5049S364S00000X
KY3005049363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000549131OtherANTHEM BCBS PIN
1629114707OtherGROUP NPI EKAHC
KY7100146710OtherMEDICAID PRIMARY CARE
KY20036018Medicaid
KY7100062200OtherNURSE PRACTITIONER MEDICAID
KYFLU0230Medicare PIN
KY0631512Medicare PIN