Provider Demographics
NPI:1013798438
Name:GOFF, KATINA GAYLE
Entity Type:Individual
Prefix:MISS
First Name:KATINA
Middle Name:GAYLE
Last Name:GOFF
Suffix:
Gender:F
Credentials:
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 976
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-0976
Mailing Address - Country:US
Mailing Address - Phone:918-413-1800
Mailing Address - Fax:
Practice Address - Street 1:27191 E 121ST ST S APT 208
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-5982
Practice Address - Country:US
Practice Address - Phone:918-413-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator