Angela Renee Goins, REGISTERED NURS, CCM

Key facts

NPI

1194484469

Entity type

Individual (NPI type 1)

Primary specialty

Case Management Registered Nurse 163WC0400X

License

77025 (TN)

Practice address

2937 Johnston Rd
Louisville, TN 37777-4105

Phone

(865) 235-6804

NPI assigned

Dec 14, 2021

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 14, 2021.

{
    "created_epoch": "1639440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639440000000",
    "number": "1194484469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2937 JOHNSTON RD",
            "city": "LOUISVILLE",
            "state": "TN",
            "postal_code": "377774105",
            "telephone_number": "865-235-6804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2937 JOHNSTON RD",
            "city": "LOUISVILLE",
            "state": "TN",
            "postal_code": "377774105",
            "telephone_number": "865-235-6804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOINS",
        "first_name": "ANGELA",
        "middle_name": "RENEE",
        "credential": "REGISTERED NURS, CCM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-14",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "TN",
            "license": "77025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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