Provider Demographics
NPI:1033517560
Name:MCCARTY, KATHERINE GOODIN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:GOODIN
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 HALE PKWY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4020
Mailing Address - Country:US
Mailing Address - Phone:303-320-8618
Mailing Address - Fax:
Practice Address - Street 1:4600 HALE PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4020
Practice Address - Country:US
Practice Address - Phone:303-320-8618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMG2479562OtherDEA