Provider Demographics
NPI:1952925612
Name:GOSHORN, KATHRYN J (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:GOSHORN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16886 W ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7039
Mailing Address - Country:US
Mailing Address - Phone:330-402-0181
Mailing Address - Fax:
Practice Address - Street 1:14441 W MCDOWELL RD STE B102
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2519
Practice Address - Country:US
Practice Address - Phone:480-504-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241678363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health