Provider Demographics
NPI:1336617059
Name:GOEBEL, MICAELA L (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MICAELA
Middle Name:L
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-0787
Mailing Address - Country:US
Mailing Address - Phone:423-658-1406
Mailing Address - Fax:865-281-1625
Practice Address - Street 1:120 TANNER PL BLDG H
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-6684
Practice Address - Country:US
Practice Address - Phone:865-264-4012
Practice Address - Fax:423-567-4722
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2019-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN3700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical