Healthcare Provider Details

I. General information

NPI: 1992668917
Provider Name (Legal Business Name): ANTOINETTE GOOSBY CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANTOINETTE NICOLE GOOSBY

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD GEORGETOWN RD STE 675
BETHESDA MD
20814-6100
US

IV. Provider business mailing address

5457 TWIN KNOLLS RD STE 300
COLUMBIA MD
21045-3296
US

V. Phone/Fax

Practice location:
  • Phone: 301-973-6102
  • Fax: 301-381-9284
Mailing address:
  • Phone: 301-973-6102
  • Fax: 301-381-9284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408135
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP500014076
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR248982
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: