Provider Demographics
NPI:1376039057
Name:GODSEY, JACY KATHLEEN (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:JACY
Middle Name:KATHLEEN
Last Name:GODSEY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:MS
Other - First Name:JACY
Other - Middle Name:KATHLEEN
Other - Last Name:CROWL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN-BSN
Mailing Address - Street 1:PO BOX 10097
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85130-0020
Mailing Address - Country:US
Mailing Address - Phone:520-836-3446
Mailing Address - Fax:
Practice Address - Street 1:23 S MCNAB PKWY
Practice Address - Street 2:
Practice Address - City:SAN MANUEL
Practice Address - State:AZ
Practice Address - Zip Code:85631-1156
Practice Address - Country:US
Practice Address - Phone:520-385-2234
Practice Address - Fax:520-381-3209
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106718363LF0000X
AZ250278363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily