Provider Demographics
NPI:1255815379
Name:GOINS, AMANDA KAY (NP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KAY
Last Name:GOINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1320 W SPENCER AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3415
Mailing Address - Country:US
Mailing Address - Phone:765-613-0111
Mailing Address - Fax:765-573-5660
Practice Address - Street 1:1320 W SPENCER AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3415
Practice Address - Country:US
Practice Address - Phone:765-613-0111
Practice Address - Fax:765-573-5660
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008383B363LP2300X
IN71008383A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care