Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 111367 | NE |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 2014043709 | MO |
NPI | 1235486366 |
---|---|
Provider Name | Mrs. Kimberly Ann Goracke |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2012 |
Last Update Date | 26/03/2015 |