Provider Demographics
NPI:1528123114
Name:GOOCH, MICHELLE ESTHER WRIGHT (ACNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ESTHER WRIGHT
Last Name:GOOCH
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8308
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-0308
Mailing Address - Country:US
Mailing Address - Phone:423-710-3864
Mailing Address - Fax:423-710-3865
Practice Address - Street 1:1301 MCCALLIE AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2934
Practice Address - Country:US
Practice Address - Phone:423-710-3864
Practice Address - Fax:423-710-3865
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13168363LA2100X, 363LF0000X
GARN212025363LF0000X
NJ26NJ00120500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33416621OtherMEDICARE PTAN
TN3341662OtherMEDICARE PTAN
TN3370172OtherMEDICARE PTAN-GROUP
TN3726561OtherMEDICARE PTAN-GROUP