Basic Information
| Provider Information | |||||||||
| NPI: | 1245204957 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOENS | ||||||||
| FirstName: | KRISTIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 9TH AVE NW | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572011548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058825455 | ||||||||
| FaxNumber: | 6058825452 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 9TH AVE NW | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572011548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058825455 | ||||||||
| FaxNumber: | 6058825452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CNP0297 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 57105F013 | 01 | SD | WPS TRICARE | OTHER | 706138200 | 05 | MN | MEDICAID | 35077 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 9240963 | 01 | SD | DAKOTACARE | OTHER | P00280018 | 01 | SD | RR MEDICARE | OTHER | 12262 | 05 | ND | MEDICAID | 769201043703 | 01 | SD | PREFERRED ONE | OTHER | 0119618 | 01 | SD | MEDICA | OTHER | 244212 | 01 | SD | MIDLANDS CHOICE | OTHER | 495T6GO | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 6825432 | 05 | SD | MEDICAID | 6825434 | 05 | SD | MEDICAID | 1056418 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | HP47806 | 01 | SD | HEALTHPARTNERS | OTHER | 0555144 | 05 | IA | MEDICAID | 46022474335 | 05 | NE | MEDICAID | 4995307 | 01 | SD | BLUE CROSS | OTHER | 92411422901 | 01 | MN | PRIMEWEST | OTHER |