Kaitlyn Goetsch, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

906555 Issued in MS

Practice address

1102 45TH Ave
Gulfport, MS 39501-2504

Phone

(228) 863-1036

NPI assigned

May 6, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ms State Department of HealthGroup PAC ID 0244129245, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Ms State Department of Health

  • Community/Behavioral Health Agency
  • Jackson, MS
  • NPI 1053489260
  Medicare reassignment Care Compare group NPD
• Mississippi State Department of Health

  • Clinical Medical Laboratory
  • Jackson, MS
  • NPI 1255479630
  NPD
• Ms State Dept of Health

  • Long Term Care Pharmacy
  • Jackson, MS
  • NPI 1376606582
  NPD

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

{
    "created_epoch": "1714953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1104673276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 E WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164538",
            "telephone_number": "601-576-7886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 45TH AVE",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395012504",
            "telephone_number": "228-863-1036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOETSCH",
        "first_name": "KAITLYN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-06",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "906555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Alexander Glenn Jr., IDC
• Meghan Elizabeth Glenn
• Global One
• April Goacher
• Abraham R Gobel, MD
• William Lacy Goff Jr., NP
• Bradley Goldenberg, MD
• Brooke Kayla Gonzales, PHARMD
• Paola Nicol Gonzalez de Jesus
• Good Heart Professional Counseling

• Family Nurse Practitioner in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.