Healthcare Provider Details

I. General information

NPI: 1366337453
Provider Name (Legal Business Name): HAILEY GOOLD ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7812 VILLANUEVA DR NE
ALBUQUERQUE NM
87109-6609
US

IV. Provider business mailing address

7812 VILLANUEVA DR NE
ALBUQUERQUE NM
87109-6609
US

V. Phone/Fax

Practice location:
  • Phone: 505-270-4683
  • Fax:
Mailing address:
  • Phone: 505-270-4683
  • Fax: 505-270-4683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-2024-0010
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: