MEDICARE: KESHA GODFREY WILLIAMS FNP

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	163W00000X	Registered Nurse	801240	TX
2	363LF0000X	Family Nurse Practitioner	AP131839	TX

General Provider Information

NPI Number	:	1912459678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KESHA GODFREY WILLIAMS FNP

Provider Business Mailing Address
First Line	:	4600 GULF FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-3548
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9919 NORTH FWY STE 107
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-1272
Country	:	US
Telephone Number	:	713-514-1107
Fax Number	:	404-494-7435

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

Provider Enumeration Date	:	10/28/2016
Last Update Date	:	03/05/2020

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