Kelly Amanda Goddard

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1851 Issued in CT

Practice address

201 Nichols Ter
Stratford, CT 06614-3959

Phone

(203) 377-1752

NPI assigned

Oct 29, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717286400000",
    "number": "1700540200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 NICHOLS TER",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066143959",
            "telephone_number": "203-377-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 NICHOLS TER",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066143959",
            "telephone_number": "203-377-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODDARD",
        "first_name": "KELLY",
        "middle_name": "AMANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-29",
        "last_updated": "2024-06-02",
        "certification_date": "2024-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CT",
            "license": "1851",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eileen Patricia Geraci, APRN
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• Katherine Glynn, LPC
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• Amber Gomes, APRN
• Anna Maria Gonzalez, MSW, LCSW

• Athletic Trainer in Stratford, CT
• Providers in Stratford, CT by specialty
• Athletic Trainer in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.