Provider Demographics
NPI:1841449667
Name:GOOSS, BRANDY (FNP)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:
Last Name:GOOSS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 DEEP WELLS RD
Mailing Address - Street 2:
Mailing Address - City:JAL
Mailing Address - State:NM
Mailing Address - Zip Code:88252-9724
Mailing Address - Country:US
Mailing Address - Phone:575-395-2495
Mailing Address - Fax:888-430-7095
Practice Address - Street 1:805 WEST KANSAS
Practice Address - Street 2:
Practice Address - City:JAL
Practice Address - State:NM
Practice Address - Zip Code:88252
Practice Address - Country:US
Practice Address - Phone:575-395-3400
Practice Address - Fax:575-395-2781
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
8L6663OtherMEDICARE PTAN