Provider Demographics
NPI:1073941498
Name:GOERING, KARISA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KARISA
Middle Name:MARIE
Last Name:GOERING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KARISA
Other - Middle Name:MARIE
Other - Last Name:WASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:412 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2947
Mailing Address - Country:US
Mailing Address - Phone:641-753-4021
Mailing Address - Fax:641-753-4025
Practice Address - Street 1:412 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-2947
Practice Address - Country:US
Practice Address - Phone:641-753-4021
Practice Address - Fax:641-753-4025
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant