Basic Information
| Provider Information | |||||||||
| NPI: | 1255365631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOSHORN | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DNP ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 E COURT AVE | ||||||||
| Address2: | STE 305 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503092057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152373974 | ||||||||
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| Practice Location | |||||||||
| Address1: | 410 E ROBINSON ST | ||||||||
| Address2: | STE A-2 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501382058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6412053100 | ||||||||
| FaxNumber: | 6412053102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 01/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | A096742 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 0074583 | 05 | IA | MEDICAID | 007458 | 01 | IA | WELLMARK/BLUE CROSS | OTHER | 1477857704 | 05 | IA | MEDICAID | 1477857704 | 01 | IA | WELLMARK BCBS | OTHER | P01035746 | 01 | IA | RR MEDICARE | OTHER |