Healthcare Provider Details

I. General information

NPI: 1942763248
Provider Name (Legal Business Name): NATHAN P GOODWIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 WORNALL RD STE 2000
KANSAS CITY MO
64111-5939
US

IV. Provider business mailing address

901 E 104TH ST # MS 400S
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-931-1883
  • Fax:
Mailing address:
  • Phone: 816-931-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2026037242
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0453654
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: