Provider Demographics
NPI:1821567231
Name:GOINS, KATHRYN ANN (BA)
Entity Type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:ANN
Last Name:GOINS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3371
Mailing Address - Country:US
Mailing Address - Phone:360-792-2020
Mailing Address - Fax:360-478-6993
Practice Address - Street 1:2625 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3371
Practice Address - Country:US
Practice Address - Phone:360-792-2020
Practice Address - Fax:360-478-6993
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60915218171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator