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General NPI Number Information
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NPI Number | 1760976617
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Entity Type | Organization
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Legal Business Name | GODLEY FAMILY MEDICINE CLINIC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 7431 SPRING RANCH CT
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City | GODLEY
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State | TX
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Zip | 76044-3855
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Country | US
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Telephone | 512-645-0181
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Fax | 512-582-8585
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Provider Business Mailing Address
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Address Line | PO BOX 682
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City | GODLEY
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State | TX
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Zip | 76044-0682
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Country | US
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Telephone | 512-645-0181
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Fax | 512-582-8585
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JOY KEETON
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Credential | FNP-C
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Telephone | 512-645-0181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP126404
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License Number State | TX
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