Healthcare Provider Details

I. General information

NPI: 1942904826
Provider Name (Legal Business Name): JASMIN GOOCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CLINIC DR
MADISONVILLE KY
42431-1661
US

IV. Provider business mailing address

200 CLINIC DR
MADISONVILLE KY
42431-1661
US

V. Phone/Fax

Practice location:
  • Phone: 270-825-6680
  • Fax: 270-825-7266
Mailing address:
  • Phone: 270-825-7390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR6793
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: