MEDICARE: ANTOINETTE GOOSBY CRNP-PMH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	408135	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP500014076	DC
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R248982	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992668917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE GOOSBY CRNP-PMH

Provider Business Mailing Address
First Line	:	5457 TWIN KNOLLS RD STE 300
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-3296
Country	:	US
Telephone Number	:	301-973-6102
Fax Number	:	301-778-2496

Provider Business Practice Location Address
First Line	:	5457 TWIN KNOLLS RD STE 300
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-3296
Country	:	US
Telephone Number	:	301-973-6102
Fax Number	:	301-778-2496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	06/08/2026

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