Provider Demographics
NPI:1932665684
Name:GOODWIN, KATHLEEN MORWOOD (PNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MORWOOD
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ERIN
Other - Last Name:MORWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 LAKESIDE AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4936
Mailing Address - Country:US
Mailing Address - Phone:802-860-1928
Mailing Address - Fax:
Practice Address - Street 1:128 LAKESIDE AVE STE 115
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4936
Practice Address - Country:US
Practice Address - Phone:802-860-1928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134277363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics