Individual provider Active NPI

Casey Goniwiecha

  • Family Nurse Practitioner
  • Cottonwood, AZ
National Provider Identifier
1497620884
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
330546 Issued in AZ
Practice address
340 S Willard St
Cottonwood, AZ 86326-4126
Phone
(928) 634-5551
NPI assigned
Oct 7, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 330546 AZ Primary

Addresses

Primary practice location

340 S Willard St
Cottonwood, AZ 86326-4126

Mailing address

317 Laughing Hill Dr
Clarkdale, AZ 86324-3389
Phone (586) 980-9785

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20251104003742 AZ Practitioner - Nurse Practitioner 6002306578 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

269 S Candy LN
Cottonwood, AZ 86326-4158
Phone (928) 639-6000

340 S Willard St
Cottonwood, AZ 86326-4126
Phone (928) 639-6025

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
330546AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Arizona Healthcare Corporation CurrentSince Nov 8, 2025 Accepting new patients
Northern Arizona Healthcare Corporation CurrentSince Nov 8, 2025 Accepting new patients

Locations

340 S Willard St
Ste 201
Cottonwood, AZ 86326
Phone (928) 634-5551

340 S Willard St
Cottonwood, AZ 86326
Phone (928) 634-5551

269 S Candy Ln
Cottonwood, AZ 86326
Phone (928) 634-2251

1215 N Beaver St
Ste 203
Flagstaff, AZ 86001
Phone (928) 773-2249

1200 N Beaver St
Ste 201
Flagstaff, AZ 86001

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1759795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1497620884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 LAUGHING HILL DR",
            "city": "CLARKDALE",
            "state": "AZ",
            "postal_code": "863243389",
            "telephone_number": "586-980-9785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 S WILLARD ST",
            "city": "COTTONWOOD",
            "state": "AZ",
            "postal_code": "863264126",
            "telephone_number": "928-634-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONIWIECHA",
        "first_name": "CASEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-07",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "330546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cottonwood, AZ

Sources for this page

Verify at the official NPI Registry.