Provider Demographics
NPI:1821047226
Name:GOODWIN, KATHERINE A (ANP CNM)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:A
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:ANP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8050
Mailing Address - Country:US
Mailing Address - Phone:907-789-1812
Mailing Address - Fax:907-789-7168
Practice Address - Street 1:2231 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8050
Practice Address - Country:US
Practice Address - Phone:907-789-1812
Practice Address - Fax:907-789-7168
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK786627363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNE78661Medicaid