Provider Demographics
NPI:1457235848
Name:GOOSSEN, ANNA ARLENE (PA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ARLENE
Last Name:GOOSSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15571 SE 160 AVE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:KS
Mailing Address - Zip Code:67118-9009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:710 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MEDICINE LODGE
Practice Address - State:KS
Practice Address - Zip Code:67104-1019
Practice Address - Country:US
Practice Address - Phone:620-886-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant