Provider Demographics
NPI:1750858643
Name:GOOCH, KRISTEN ELENA (NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELENA
Last Name:GOOCH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8TH AVENUE C ST E
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84143-1857
Mailing Address - Country:US
Mailing Address - Phone:801-408-3858
Mailing Address - Fax:
Practice Address - Street 1:36 S STATE ST STE 2100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1472
Practice Address - Country:US
Practice Address - Phone:801-442-2840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6849506-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care