Provider Demographics
NPI:1669448718
Name:GOALEY, PATRICIA ANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:GOALEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:MCCAULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1445 STILLWATER RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-7612
Mailing Address - Country:US
Mailing Address - Phone:254-537-3714
Mailing Address - Fax:
Practice Address - Street 1:1445 STILLWATER RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-7612
Practice Address - Country:US
Practice Address - Phone:254-537-3714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004408363A00000X
VA0110840722363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant