Provider Demographics
NPI:1881682581
Name:GOLDMAN, CHRISTI M (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:M
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:STE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-585-4321
Mailing Address - Fax:502-587-8306
Practice Address - Street 1:6420 DUTCHMANS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3373
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:502-891-8338
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000576A363AM0700X
KYPA675363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95002119Medicaid
P44759Medicare UPIN
KY1273221Medicare PIN
KY95002119Medicaid
IN126930RMedicare PIN
KYP00655137Medicare PIN
IN228550JMedicare PIN