Provider Demographics
NPI:1902453327
Name:GODSEY, EMILY LAUREN (RN)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:LAUREN
Last Name:GODSEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:LAUREN
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1510 S VINE AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1510 S VINE AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2826
Practice Address - Country:US
Practice Address - Phone:903-526-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX764810163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)