MEDICARE: KATELYN GOFF PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601010273	MI

General Provider Information

NPI Number	:	1013506625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN GOFF PA

Provider Business Mailing Address
First Line	:	20095 GILBERT RD
Second Line	:
City	:	BIG RAPIDS
State	:	MI
Zip	:	49307-2365
Country	:	US
Telephone Number	:	231-592-1360
Fax Number	:	231-592-1361

Provider Business Practice Location Address
First Line	:	4024 PARK EAST CT SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-8810
Country	:	US
Telephone Number	:	231-592-1360
Fax Number	:	231-592-1361

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2021
Last Update Date	:	10/21/2025

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Directions to “ KATELYN GOFF PA” Practice Location

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