Basic Information
| Provider Information | |||||||||
| NPI: | 1598382244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDSWORTHY | ||||||||
| FirstName: | KATHY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2168 | ||||||||
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| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897022168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457360 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 MEDICAL CENTER DR STE 203 | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894037459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457630 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2020 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 831698 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.