MEDICARE: MRS. ANGELA RENEE GOFF FNP-BC

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	2020040019	WV

General Provider Information

NPI Number	:	1942816137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA RENEE GOFF FNP-BC

Provider Business Mailing Address
First Line	:	211 W MAPLE AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	WV
Zip	:	25840-1445
Country	:	US
Telephone Number	:	304-900-5511
Fax Number	:	304-900-5554

Provider Business Practice Location Address
First Line	:	211 W MAPLE AVE
Second Line	:
City	:	FAYETTEVILLE
State	:	WV
Zip	:	25840-1445
Country	:	US
Telephone Number	:	304-900-5511
Fax Number	:	304-900-5554

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

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	04/08/2026

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