Healthcare Provider Details

I. General information

NPI: 1598382244
Provider Name (Legal Business Name): KATHY GOLDSWORTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 ELM ST STE 401
RENO NV
89503-4541
US

IV. Provider business mailing address

343 ELM ST STE 401
RENO NV
89503-4541
US

V. Phone/Fax

Practice location:
  • Phone: 775-829-1009
  • Fax: 775-829-9330
Mailing address:
  • Phone: 775-829-1009
  • Fax: 775-829-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number831698
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: