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General NPI Number Information
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NPI Number | 1013840073
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Entity Type | Individual
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Provider Name | JENNY KISSELL GOOCH
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Gender | Female
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 120 PAGE RD N STE 2
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City | PINEHURST
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State | NC
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Zip | 28374-4607
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Country | US
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Telephone | 910-715-1064
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Fax |
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Provider Business Mailing Address
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Address Line | 155 MEMORIAL DR
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City | PINEHURST
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State | NC
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Zip | 28374-8710
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Country | US
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Telephone | 910-715-1064
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208U00000X
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Taxonomy Name | Clinical Pharmacology Physician
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License Number | 26026
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License Number State | NC
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