Provider Demographics
NPI:1356527311
Name:GOINS, PENNIE FAITH (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:PENNIE
Middle Name:FAITH
Last Name:GOINS
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2312
Mailing Address - Country:US
Mailing Address - Phone:304-487-7726
Mailing Address - Fax:304-431-5263
Practice Address - Street 1:122 12TH ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2312
Practice Address - Country:US
Practice Address - Phone:304-487-7726
Practice Address - Fax:304-431-5263
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN59978FNP-BC363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001907295OtherBCBS
WV002012533OtherBCBS
WV0022360001Medicaid
WV3810011123Medicaid
WVCD7656OtherRR MC
WV0035334000Medicaid
WVCD7656OtherRR MC
WVGO2029902Medicare PIN
WV5118601Medicare Oscar/Certification
WV0022360001Medicaid
WV001907295OtherBCBS
WV5118561Medicare Oscar/Certification