Penny Goudelock, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA10005160 Issued in WA

Practice address

1100 Pacific Ave
Suite 202
Everett, WA 98201-4261

Phone

(425) 388-4075

NPI assigned

Apr 11, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• American Current Care of Washington, P.S.

  • Urgent Care Clinic/Center
  • Seattle, WA
  • NPI 1073096871
  Medicare reassignment
• American Current Care of Washington, P.S.

  • Urgent Care Clinic/Center
  • Spokane, WA
  • NPI 1881177681
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1043433352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18012 W VALLEY HWY",
            "address_2": "STE 101",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980322924",
            "telephone_number": "425-291-3300",
            "fax_number": "425-291-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 PACIFIC AVE",
            "address_2": "SUITE 202",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014261",
            "telephone_number": "425-388-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUDELOCK",
        "first_name": "PENNY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10005160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8485898",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Divine Grace Gorospe, ARNP
• Tiffany D Gorski, MSW
• Yin-Yin NG Goshert, DPT
• Nicole Goss, LMT
• Gothic Sage Therapy and Design PLLC
• Andrea Gougian, MA CCC-SLP
• Randall K. Gould, M.D.
• Delaney Conway Goulet, M.D.
• Dennis Goulet
• Abishak Govindarajan

• Medical Physician Assistant in Everett, WA
• Providers in Everett, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.