Healthcare Provider Details

I. General information

NPI: 1801382536
Provider Name (Legal Business Name): JENNIFER GODBOLD DNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 BARTLETT ST
HOMER AK
99603-7000
US

IV. Provider business mailing address

4300 BARTLETT ST
HOMER AK
99603-7000
US

V. Phone/Fax

Practice location:
  • Phone: 907-226-5630
  • Fax:
Mailing address:
  • Phone: 907-226-5630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: