Healthcare Provider Details

I. General information

NPI: 1568088177
Provider Name (Legal Business Name): DANIELLE GOOLSBY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 HWY 111
BYRDSTOWN TN
38549-1006
US

IV. Provider business mailing address

8401 HWY 111
BYRDSTOWN TN
38549-1006
US

V. Phone/Fax

Practice location:
  • Phone: 931-864-3187
  • Fax: 931-864-7102
Mailing address:
  • Phone: 931-864-3187
  • Fax: 931-864-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27727
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: