Xia Goudeaux Howard, ATC
Individual provider Active NPI Athletic Trainer · Newark, DE
NPI 1093398786 · NPPES record last updated Apr 30, 2021
Key facts
- NPI
- 1093398786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 2000039216 (DE)
- Practice address
- 103 Cannonball LN
Newark, DE 19702-3097 - Phone
- (302) 588-4203
- NPI assigned
- Apr 30, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000039216 | DE | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000039216 | DE | Yes |
Addresses
Primary practice location
103 Cannonball LN
Newark, DE 19702-3097
Mailing address
103 Cannonball LN
Newark, DE 19702-3097
Phone (302) 588-4203
Other providers in Newark, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.