Healthcare Provider Details

I. General information

NPI: 1942240338
Provider Name (Legal Business Name): NILA GODFREY P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21820 KATY FWY STE 200
KATY TX
77449-7901
US

IV. Provider business mailing address

9235 KATY FWY STE 400
HOUSTON TX
77024-1507
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-2915
  • Fax: 713-461-5307
Mailing address:
  • Phone: 713-461-2915
  • Fax: 713-461-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00840
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: