Provider Demographics
NPI:1831976893
Name:GOFFNEY, DETRIA
Entity type:Individual
Prefix:
First Name:DETRIA
Middle Name:
Last Name:GOFFNEY
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 1:903 ADOWA SPRING LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-4605
Mailing Address - Country:US
Mailing Address - Phone:832-883-6600
Mailing Address - Fax:
Practice Address - Street 1:903 ADOWA SPRING LOOP
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-4605
Practice Address - Country:US
Practice Address - Phone:832-883-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)