Healthcare Provider Details

I. General information

NPI: 1669917688
Provider Name (Legal Business Name): DEANNA LYNN GOFF APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANNA LYNN KOCH

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 03/08/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 MAIN ST
SABETHA KS
66534-1832
US

IV. Provider business mailing address

1110 COLUMBINE DRIVE
HOLTON KS
66436
US

V. Phone/Fax

Practice location:
  • Phone: 785-284-2141
  • Fax: 785-284-0022
Mailing address:
  • Phone: 785-364-2116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016044689
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number78168
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: