Healthcare Provider Details

I. General information

NPI: 1194293126
Provider Name (Legal Business Name): ADAM GOINS AGPCNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DRIVE
CLEVELAND OH
44109
US

IV. Provider business mailing address

101 WINSTON WAY LOT E
CAMPBELLSVILLE KY
42718-4963
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-5736
  • Fax:
Mailing address:
  • Phone: 270-789-0034
  • Fax: 270-789-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0027751
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3012868
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: