Healthcare Provider Details

I. General information

NPI: 1982430294
Provider Name (Legal Business Name): VANDI GOOCH MHA, MSN, APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N ELM ST
HENDERSON KY
42420-2783
US

IV. Provider business mailing address

3223 KEYSTONE HILLS DR
EVANSVILLE IN
47711-2229
US

V. Phone/Fax

Practice location:
  • Phone: 270-957-8800
  • Fax: 270-957-8797
Mailing address:
  • Phone: 812-449-6848
  • Fax: 270-957-8797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4026764
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4026764
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28187478A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28187478C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: