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Individual
MS. MICHELLE K. GOUGH
Active
Individual
MS. MICHELLE K. GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-01184
KS
363A00000X
Physician Assistant
T-01568
KS
363AM0700X
Medical Physician Assistant
PA9105990
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006452800
—
FL
01
—
016576006
MEDICARE
KS
05
—
200535850B
—
KS
Enumeration date
09/24/2007
Last updated
08/19/2020
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