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General NPI Number Information
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NPI Number | 1013506625
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Entity Type | Individual
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Provider Name | KATELYN GOFF PA
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Gender | Female
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Dates
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Enumeration Date | 01/18/2021
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 4024 PARK EAST CT SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8810
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Country | US
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Telephone | 231-592-1360
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Fax | 231-592-1361
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Provider Business Mailing Address
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Address Line | 20095 GILBERT RD
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City | BIG RAPIDS
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State | MI
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Zip | 49307-2365
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Country | US
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Telephone | 231-592-1360
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Fax | 231-592-1361
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601010273
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License Number State | MI
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