MEDICARE: MISS KELLY GODFREY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3747P1801X	Personal Care Attendant
2	376J00000X	Homemaker
3	374U00000X	Home Health Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740896109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KELLY GODFREY

Provider Business Mailing Address
First Line	:	55 VAUGHN RD
Second Line	:
City	:	DELAWARE
State	:	OH
Zip	:	43015-2280
Country	:	US
Telephone Number	:	740-816-4223
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 BLUE SPRUCE CT
Second Line	:
City	:	DELAWARE
State	:	OH
Zip	:	43015-4005
Country	:	US
Telephone Number	:	740-816-4223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	09/21/2020

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Directions to “ MISS KELLY GODFREY ” Practice Location

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