Individual
KELLIE ANN P GOUDREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, PA-C
Contact information
Practice address
144 STATE ST, PORTLAND, ME 04101-3776
(207) 879-3000
Mailing address
144 STATE ST, PORTLAND, ME 04101-3776
(207) 604-0298
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
PA1775
ME
363AM0700X
Medical Physician Assistant
PA1775
ME
363AM0700X
Medical Physician Assistant
PA2012-0052
NM
Other
Enumeration date
08/31/2011
Last updated
12/05/2024
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