Provider Demographics
NPI:1861993701
Name:GODETT, KRISTEN (NURSE PRACTIONER)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GODETT
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 MED CT STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3484
Mailing Address - Country:US
Mailing Address - Phone:210-494-4290
Mailing Address - Fax:210-494-4809
Practice Address - Street 1:607 CAMDEN ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1610
Practice Address - Country:US
Practice Address - Phone:211-023-3712
Practice Address - Fax:855-838-0423
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2023-01-30
Deactivation Date:2021-08-28
Deactivation Code:
Reactivation Date:2021-09-14
Provider Licenses
StateLicense IDTaxonomies
TX1052585207R00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine