Healthcare Provider Details

I. General information

NPI: 1427377498
Provider Name (Legal Business Name): TERRA DEANN GOANS RN, BSN, BS, AS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERRA DEANN LEAVENGOOD

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W MAPLE AVE
ENID OK
73701-4027
US

IV. Provider business mailing address

121 W MAPLE AVE
ENID OK
73701-4027
US

V. Phone/Fax

Practice location:
  • Phone: 580-234-8865
  • Fax: 580-234-8361
Mailing address:
  • Phone: 580-234-8865
  • Fax: 580-234-8361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: