Provider Demographics
NPI:1215685318
Name:GOFF, BENJAMIN TYLER BRANDON (RN)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:TYLER BRANDON
Last Name:GOFF
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2411
Mailing Address - Country:US
Mailing Address - Phone:276-345-5056
Mailing Address - Fax:
Practice Address - Street 1:111 TOWN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-9622
Practice Address - Country:US
Practice Address - Phone:276-963-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001266334163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse