1245204957 NPI number — KRISTIE L GOENS CNP

Table of content: KRISTIE L GOENS CNP (NPI 1245204957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245204957 NPI number — KRISTIE L GOENS CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOENS
Provider First Name:
KRISTIE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245204957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 9TH AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57201-1548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-882-5455
Provider Business Mailing Address Fax Number:
605-882-5452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 9TH AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57201-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-882-5455
Provider Business Practice Location Address Fax Number:
605-882-5452
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  CNP0297 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 57105F013 . This is a "WPS TRICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 706138200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35077 . This is a "SANFORD HEALTH PLAN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 9240963 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: P00280018 . This is a "RR MEDICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 12262 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 769201043703 . This is a "PREFERRED ONE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 0119618 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 244212 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 495T6GO . This is a "CC SYSTEMS/ BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6825432 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6825434 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1056418 . This is a "ARAZ/ AMERICA'S PPO" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: HP47806 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 0555144 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 46022474335 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4995307 . This is a "BLUE CROSS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 92411422901 . This is a "PRIMEWEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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