Provider Demographics
NPI:1245191790
Name:GODLEY, JENICE (MSN, APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:JENICE
Middle Name:
Last Name:GODLEY
Suffix:
Gender:F
Credentials:MSN, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 N STEMMONS FWY STE 200S
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-3821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8585 N STEMMONS FWY STE 200S
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-3821
Practice Address - Country:US
Practice Address - Phone:803-873-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-22
Last Update Date:2025-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1217489363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care