Healthcare Provider Details

I. General information

NPI: 1215831599
Provider Name (Legal Business Name): AVERY L GOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 WERNER DR
NEW ORLEANS LA
70126-4445
US

IV. Provider business mailing address

7230 THORNLEY DR
NEW ORLEANS LA
70126-2130
US

V. Phone/Fax

Practice location:
  • Phone: 504-913-1865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP248860
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: