Provider Demographics
NPI:1790101905
Name:GOULDING, KATHERINE (CNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:GOULDING
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 1:12931 PRAIRIEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-8104
Mailing Address - Country:US
Mailing Address - Phone:605-380-8487
Mailing Address - Fax:
Practice Address - Street 1:422 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-8104
Practice Address - Country:US
Practice Address - Phone:605-725-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000849363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDCP000849Medicaid