Provider Demographics
NPI:1063622017
Name:GOETTEL, KATHLEEN CORCORAN (RN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:CORCORAN
Last Name:GOETTEL
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8335 WALNUT HILL LN STE 220
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4204
Mailing Address - Country:US
Mailing Address - Phone:214-696-0222
Mailing Address - Fax:
Practice Address - Street 1:8335 WALNUT HILL LN STE 220
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4204
Practice Address - Country:US
Practice Address - Phone:214-696-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX655379363LP0200X
TXAP109132363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics