Healthcare Provider Details

I. General information

NPI: 1871337790
Provider Name (Legal Business Name): KATTALEYA ANGKANA GOULD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HANOVER ST STE 3A
FALL RIVER MA
02720-5498
US

IV. Provider business mailing address

90 BOXWOOD LN
BRIDGEWATER MA
02324-2255
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-7770
  • Fax:
Mailing address:
  • Phone: 508-846-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: