Healthcare Provider Details

I. General information

NPI: 1568414902
Provider Name (Legal Business Name): PRISCILLA GOOSLIN CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 HOSPITAL DR # 202D
SOUTH WILLIAMSON KY
41503-4095
US

IV. Provider business mailing address

306 HOSPITAL DR STE 202D
SOUTH WILLIAMSON KY
41503-4095
US

V. Phone/Fax

Practice location:
  • Phone: 606-237-1516
  • Fax: 606-237-4955
Mailing address:
  • Phone: 606-237-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number42926
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: