Provider Demographics
NPI:1821278961
Name:GOFF, JEANNIE MARIE (MSN, APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:JEANNIE
Middle Name:MARIE
Last Name:GOFF
Suffix:
Gender:F
Credentials:MSN, APRN-BC
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:MARIE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1212 GARFIELD AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3247
Mailing Address - Country:US
Mailing Address - Phone:304-865-3635
Mailing Address - Fax:
Practice Address - Street 1:1212 GARFIELD AVE STE 300
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3247
Practice Address - Country:US
Practice Address - Phone:304-865-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14041-NP363LF0000X
WV58333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01165610OtherRAILROAD MEDICARE MHCPI
OH2937353Medicaid
WV3810012180Medicaid
OHP01165610OtherRAILROAD MEDICARE MHCPI
OHH142240Medicare PIN