MEDICARE: DR. KRISTIN L. GOODHEART PH.D.

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	103TC0700X	Clinical Psychologist	2180	KS

General Provider Information

NPI Number	:	1144581489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIN L. GOODHEART PH.D.

Provider Business Mailing Address
First Line	:	8918 W 21ST ST N
Second Line	:	STE 200, BOX 215
City	:	WICHITA
State	:	KS
Zip	:	67205
Country	:	US
Telephone Number	:	785-623-0303
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 N TYLER RD STE 201
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67212-3266
Country	:	US
Telephone Number	:	785-247-6288
Fax Number	:	785-444-6468

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

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	03/24/2026

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