Provider Demographics
NPI:1245204957
Name:GOENS, KRISTIE L (CNP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:L
Last Name:GOENS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 9TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1548
Mailing Address - Country:US
Mailing Address - Phone:605-882-5455
Mailing Address - Fax:605-882-5452
Practice Address - Street 1:401 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1548
Practice Address - Country:US
Practice Address - Phone:605-882-5455
Practice Address - Fax:605-882-5452
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCNP0297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD57105F013OtherWPS TRICARE
MN706138200Medicaid
SD35077OtherSANFORD HEALTH PLAN
SD9240963OtherDAKOTACARE
SDP00280018OtherRR MEDICARE
ND12262Medicaid
SD769201043703OtherPREFERRED ONE
SD0119618OtherMEDICA
SD244212OtherMIDLANDS CHOICE
MN495T6GOOtherCC SYSTEMS/ BLUE PLUS
SD6825432Medicaid
SD6825434Medicaid
SD1056418OtherARAZ/ AMERICA'S PPO
SDHP47806OtherHEALTHPARTNERS
IA0555144Medicaid
NE46022474335Medicaid
SD4995307OtherBLUE CROSS
MN92411422901OtherPRIMEWEST
SD4995307OtherBLUE CROSS
NE46022474335Medicaid
SDS42147Medicare PIN
SDS103358Medicare PIN