Provider Demographics
NPI:1942816137
Name:GOFF, ANGELA RENEE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RENEE
Last Name:GOFF
Suffix:
Gender:F
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 1:119 MAIN ST W STE A
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2972
Mailing Address - Country:US
Mailing Address - Phone:304-465-0544
Mailing Address - Fax:
Practice Address - Street 1:119 MAIN ST W STE A
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2972
Practice Address - Country:US
Practice Address - Phone:304-465-0544
Practice Address - Fax:304-465-5822
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2020040019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty