Healthcare Provider Details

I. General information

NPI: 1386096584
Provider Name (Legal Business Name): ERIN GOSS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N MAIN ST
HACKETT AR
72937-8801
US

IV. Provider business mailing address

215 N MAIN ST
HACKETT AR
72937-8801
US

V. Phone/Fax

Practice location:
  • Phone: 479-255-6095
  • Fax: 479-255-6141
Mailing address:
  • Phone: 479-255-6095
  • Fax: 479-255-6141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9458201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: