Provider Demographics
NPI:1598382244
Name:GOLDSWORTHY, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:GOLDSWORTHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-2168
Mailing Address - Country:US
Mailing Address - Phone:775-445-7360
Mailing Address - Fax:
Practice Address - Street 1:901 MEDICAL CENTER DR STE 203
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-7459
Practice Address - Country:US
Practice Address - Phone:775-445-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV831698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily