Provider Demographics
NPI:1639542475
Name:GOEBEL, KRISTEN E
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 BROADCASTING RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3222
Mailing Address - Country:US
Mailing Address - Phone:610-372-8995
Mailing Address - Fax:
Practice Address - Street 1:1320 BROADCASTING RD
Practice Address - Street 2:STE 200
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3222
Practice Address - Country:US
Practice Address - Phone:610-372-8995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant