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General NPI Number Information
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NPI Number | 1861993701
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Entity Type | Individual
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Provider Name | KRISTEN GODETT NURSE PRACTIONER
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Gender | Female
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 607 CAMDEN ST
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City | SAN ANTONIO
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State | TX
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Zip | 78215-1610
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Country | US
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Telephone | 211-023-3712
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Fax | 855-838-0423
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Provider Business Mailing Address
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Address Line | 510 MED CT STE 210
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3484
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Country | US
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Telephone | 210-494-4290
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Fax | 210-494-4809
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1052585
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1052585
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License Number State | TX
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