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General NPI Number Information
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NPI Number | 1750995643
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Entity Type | Organization
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Legal Business Name | DIANE GOETZ FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 3000 ALVEY PARK DR W STE D
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City | OWENSBORO
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State | KY
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Zip | 42303-4099
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Country | US
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Telephone | 270-215-7744
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 ALVEY PARK DR W STE D
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City | OWENSBORO
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State | KY
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Zip | 42303-4099
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Country | US
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Telephone | 270-215-7744
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIANE GOETZ
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Credential | NP
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Telephone | 270-215-7744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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