Healthcare Provider Details

I. General information

NPI: 1487570594
Provider Name (Legal Business Name): HAILEY GOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 N FOURTH ST STE 301
LONGVIEW TX
75605-0037
US

IV. Provider business mailing address

3535 N FOURTH ST STE 301
LONGVIEW TX
75605-0037
US

V. Phone/Fax

Practice location:
  • Phone: 903-234-9992
  • Fax: 903-234-8287
Mailing address:
  • Phone: 903-234-9992
  • Fax: 903-234-8287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1251113
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: