Provider Demographics
NPI:1538583158
Name:GOINS, STEPHANIE DANIELLE (APRN, PMHNP-BC,FNP-C)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:DANIELLE
Last Name:GOINS
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC,FNP-C
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:DANIELLE
Other - Last Name:GOINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, PMHNP-BC,FNP-C
Mailing Address - Street 1:125 W LOTHBURY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2881
Mailing Address - Country:US
Mailing Address - Phone:606-248-5322
Mailing Address - Fax:606-248-9244
Practice Address - Street 1:125 W LOTHBURY AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2881
Practice Address - Country:US
Practice Address - Phone:606-248-5322
Practice Address - Fax:606-248-9244
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006512363LF0000X, 363LP0808X
TN19508363LF0000X, 363LP0808X
KY3008514363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100357680Medicaid