Provider Demographics
NPI:1750568507
Name:GOOCH, CHRISTINE K (OPA-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:K
Last Name:GOOCH
Suffix:
Gender:F
Credentials:OPA-C
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:K
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4031 W PLANO PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5617
Mailing Address - Country:US
Mailing Address - Phone:972-964-3469
Mailing Address - Fax:972-964-3469
Practice Address - Street 1:4031 W PLANO PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5617
Practice Address - Country:US
Practice Address - Phone:972-964-3469
Practice Address - Fax:972-964-3469
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant