Healthcare Provider Details

I. General information

NPI: 1114420429
Provider Name (Legal Business Name): GODWIN NECKMEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 N PARK RD STE 200
WYOMISSING PA
19610-1341
US

IV. Provider business mailing address

109 AUTUMNWOOD DR
MANSFIELD TX
76063-8645
US

V. Phone/Fax

Practice location:
  • Phone: 610-670-9800
  • Fax: 610-670-9800
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number269313
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number918855
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: