Provider Demographics
NPI:1063283869
Name:GODSEY, KATELYN VIRGINIA
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:VIRGINIA
Last Name:GODSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:VIRGINIA
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2405 YELLOW BIRCH WAY APT 108
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-2779
Mailing Address - Country:US
Mailing Address - Phone:865-660-4846
Mailing Address - Fax:
Practice Address - Street 1:2405 YELLOW BIRCH WAY APT 108
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-2779
Practice Address - Country:US
Practice Address - Phone:865-660-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000244972163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse