Provider Demographics
NPI:1396027249
Name:DUGGER- GOODRICH, KATHRYN JENNIFER
Entity type:Individual
Prefix:MISS
First Name:KATHRYN
Middle Name:JENNIFER
Last Name:DUGGER- GOODRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3924
Mailing Address - Country:US
Mailing Address - Phone:508-791-2508
Mailing Address - Fax:
Practice Address - Street 1:515 MIDDLE TPKE W
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3816
Practice Address - Country:US
Practice Address - Phone:860-533-4176
Practice Address - Fax:860-649-5219
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11805363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily