Provider Demographics
NPI:1447795661
Name:GOSHEN, KIRSTEN (FNP)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:GOSHEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 570
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1224
Mailing Address - Country:US
Mailing Address - Phone:858-457-4917
Mailing Address - Fax:858-457-3287
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 570
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-457-4917
Practice Address - Fax:858-457-3287
Is Sole Proprietor?:No
Enumeration Date:2016-12-24
Last Update Date:2016-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily