MEDICARE: JENNIFER GODLEY PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	270065	AZ

General Provider Information

NPI Number	:	1689328197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GODLEY PMHNP

Provider Business Mailing Address
First Line	:	5529 W PARSONS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-7449
Country	:	US
Telephone Number	:	623-337-0089
Fax Number	:

Provider Business Practice Location Address
First Line	:	10220 N 31ST AVE STE 220
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9581
Country	:	US
Telephone Number	:	480-647-2279
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2022
Last Update Date	:	03/16/2026

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