MEDICARE: CINDY R GOSHORN DNP ARNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	A096742	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P01035746	OTHER	IA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1477857704	OTHER	IA	WELLMARK BCBS
2	007458	OTHER	IA	WELLMARK/BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255365631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDY R GOSHORN DNP ARNP

Provider Business Mailing Address
First Line	:	1501 50TH ST STE 110
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-5940
Country	:	US
Telephone Number	:	515-237-3974
Fax Number	:	888-503-7693

Provider Business Practice Location Address
First Line	:	935 W 18TH ST S
Second Line	:
City	:	NEWTON
State	:	IA
Zip	:	50208-3500
Country	:	US
Telephone Number	:	641-871-0764
Fax Number	:	641-792-2745

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	12/18/2024

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