Adam Brock Goforth Valid NPI

Individual provider · Psychiatric/Mental Health Nurse Practitioner · Anna, IL

NPI

1356173124

Type

Individual (Type 1)

Primary specialty

Psychiatric/Mental Health Nurse Practitioner (Nurse Practitioner)

Specialty group

Physician Assistants & Advanced Practice Nursing Providers

Taxonomy code

363LP0808X

License number

209.030398 (IL)

Sex

Male

Sole proprietor

No

Enumerated

2024-08-19

Last updated

2024-12-09