MEDICARE: ALANTA JADE GOGGINS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	906117	MS

General Provider Information

NPI Number	:	1578337465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALANTA JADE GOGGINS FNP-C

Provider Business Mailing Address
First Line	:	188 STARLYN AVE
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-2436
Country	:	US
Telephone Number	:	662-486-2700
Fax Number	:	662-486-2702

Provider Business Practice Location Address
First Line	:	188 STARLYN AVE
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-2436
Country	:	US
Telephone Number	:	662-486-2700
Fax Number	:	662-486-2702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2023
Last Update Date	:	11/10/2023

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