PENNY GOUDELOCK (NPI# 1043433352) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043433352 |
| Entity Type | Individual |
| Full Name | PENNY GOUDELOCK |
| Credential | PA |
| Practice Address |
1100 Pacific Ave Suite 202 Everett WA 98201-4261 |
| Mailing Address |
18012 W Valley Hwy Ste 101 Kent WA 98032-2924 |
| Practice Telephone | 4253884075 |
| Mailing Telephone | 4252913300 |
| Mailing Fax Number | 4252915300 |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-04-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA10005160 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 8485898 | 05 |
| Street Address |
1100 PACIFIC AVE SUITE 202 |
| City | EVERETT |
| State | WA |
| Zip Code | 98201-4261 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073503181 | Roxanne E Hertzog | Anesthesiology | 1100 Pacific Ave, Suite 100, Everett, WA 98201-4261 | 2005-10-28 |
| 1659751949 | Melissa Ann Morris | Registered Nurse | 1100 Pacific Ave, Suite 300, Everett, WA 98201-4261 | 2015-06-02 |
| 1073847240 | Mono Nhean | Occupational Therapist | 1100 Pacific Ave, Suite 201, Everett, WA 98201-4261 | 2009-09-21 |
| 1083871305 | Douglas D Nowak | Orthopaedic Surgery | 1100 Pacific Ave, Suite 300, Everett, WA 98201-4261 | 2008-05-22 |
| 1003082017 | John D Pryor | Orthopaedic Surgery | 1100 Pacific Ave, Suite 300, Everett, WA 98201-4261 | 2008-04-30 |
| 1245412535 | Mark Western Mashita | Physician Assistant | 1100 Pacific Ave, Suite 300, Everett, WA 98201-4261 | 2007-11-29 |
| 1801001805 | Alex H Kang | Dentist | 1100 Pacific Ave, Suite 200, Everett, WA 98201-4261 | 2007-05-12 |
| 1922132646 | Christine L Hayes | Registered Nurse | 1100 Pacific Ave, Suite 300, Everett, WA 98201-4261 | 2007-03-15 |
| 1003945643 | Richard L Semon | Orthopaedic Surgery | 1100 Pacific Ave, Suite 300, Everett, WA 98201-4261 | 2007-03-02 |
| 1659458149 | Outpatient Anesthesia Services, Pllc | Anesthesiology | 1100 Pacific Ave, Suite 100, Everett, WA 98201-4261 | 2006-11-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306471867 | Shannon Michelle Dewald | Registered Nurse | D8s 1700 13th St, Everett, WA 98201 | 2020-03-05 |
| 1578123113 | Precious Medicial Spa, LLC | Registered Nurse | 1728 W. Marine View Dr Suite 212, Everett, WA 98201 | 2019-06-17 |
| 1508429796 | Alix Deschain | Counselor | 2801 Broadway, Everett, WA 98201 | 2019-04-15 |
| 1811457534 | Khushboo Patel | Pharmacist | 1330 Rockefeller Ave Ste 150, Everett, WA 98201 | 2019-03-20 |
| 1164991188 | Grace Talbot Davis | Registered Nurse | 2601 Summit Avenue, Bldg. C, Everett, WA 98201 | 2018-11-20 |
| 1063924603 | Tracy Sisk | Counselor | 3120 Colby Ave, 502, Everett, WA 98201 | 2017-11-03 |
| 1710403126 | Michelle Durham | Counselor | 3322 Boadway Fl 2, Everett, WA 98201 | 2017-08-17 |
| 1861927949 | Melanie Schmidt | Counselor | 2610 Westmore Ave, Everett, WA 98201 | 2017-04-26 |
| 1518413327 | Joseph Madson Dmd Pllc | Clinic/Center | 3802 Colby Ave, 4th Floor, Everett, WA 98201 | 2016-08-31 |
| 1043683162 | Jennifer Adams | Counselor | 1511 26th St, Everett, WA 98201 | 2015-11-11 |
| Find all providers in zip 98201 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407997588 | Stuart M Austin | Physician Assistant | 11001 31st Pl W, Suite 1, Everett, WA 98204-1323 | 2007-02-09 |
| 1639274996 | Philip Kucas | Physician Assistant | 227 Hospital Drive, Suite 1, Everett, PA 15537 | 2006-09-13 |
| 1215960372 | Randall C Dickson | Physician Assistant | 1001 North Broadway, Suite A11, Everett, WA 98201 | 2006-07-09 |
| 1366435943 | John F Matista | Physician Assistant | 1330 Rockefeller Ave, Suite 225, Everett, WA 98201-1684 | 2005-08-29 |
| 1942854864 | Taylor Marie Trypus | Physician Assistant | 10455 Lincoln Hwy, Everett, PA 15537-7046 | 2019-07-29 |
| 1972165496 | Katelyn Marie Clark | Physician Assistant | 10455 Lincoln Hwy, Everett, PA 15537-7046 | 2019-07-04 |
| 1952887564 | Brian Thomas Goss | Physician Assistant | 202 Memorial Dr Ste 2, Everett, PA 15537-7057 | 2018-07-17 |
| 1861940504 | Lindsay Cook Mertz | Physician Assistant | 1330 Rockefeller Ave, Suite 310, Everett, WA 98201-1684 | 2016-09-12 |
| 1417304650 | Sara Helvestine | Physician Assistant | 2930 Maple St, Everett, WA 98201-3832 | 2016-05-18 |
| 1962807511 | Amy Y Kim | Physician Assistant | 3927 Rucker Ave, Everett, WA 98201-4833 | 2014-10-24 |
| Find all providers in EVERETT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.