Provider Demographics
NPI:1578087169
Name:GOOSS, JAMES (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GOOSS
Suffix:
Gender:M
Credentials:FNP-BC
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 Z
Mailing Address - Street 2:
Mailing Address - City:JAL
Mailing Address - State:NM
Mailing Address - Zip Code:88252-2525
Mailing Address - Country:US
Mailing Address - Phone:575-395-3400
Mailing Address - Fax:
Practice Address - Street 1:805 WEST KANSAS AVENUE
Practice Address - Street 2:
Practice Address - City:JAL
Practice Address - State:NM
Practice Address - Zip Code:88252
Practice Address - Country:US
Practice Address - Phone:575-395-3400
Practice Address - Fax:575-395-2781
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily