Basic Information
| Provider Information | |||||||||
| NPI: | 1639762255 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GODSEY | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14020 S CARRIAGE LN | ||||||||
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| City: | MIDLOTHIAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231144331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043104450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1250 E MARSHALL ST | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232985023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048289000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2021 | ||||||||
| LastUpdateDate: | 02/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 0024180926 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.