Healthcare Provider Details

I. General information

NPI: 1003573114
Provider Name (Legal Business Name): KATHRYN JOSEPHINE GOSS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 ALAMEDA AVE
EL PASO TX
79905-2705
US

IV. Provider business mailing address

5773 CORSICANA AVE
EL PASO TX
79924-1312
US

V. Phone/Fax

Practice location:
  • Phone: 915-298-5444
  • Fax:
Mailing address:
  • Phone:
  • Fax: 915-242-8437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1057013
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number1057013
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: