KELLIE ANN P GOUDREAU MS PA-C NPI 1235410515

NPI Information

NPI: 1235410515
Provider Name: KELLIE ANN P GOUDREAU, MS, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: MERCY HOSPITAL

PECOS Registration: Yes

Address:
144 STATE ST
PORTLAND, ME
ZIP 04101
Phone: (207) 879-3000
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Kellie Ann P Goudreau, MS, PA-C is a medical physician assistant in Portland, ME with 13 years of experience. Kellie Ann P Goudreau, MS, PA-C NPI is 1235410515. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

144 STATE ST
PORTLAND, ME
ZIP 04101-776
Phone: (207) 879-3000

The NPI 1235410515 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/31/2011 and was last updated on 6/9/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA1775	MAINE	Yes
2	363AM0700X	Physician Assistant	Medical	PA2012-0052	NEW MEXICO	No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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