Provider Demographics
NPI:1114197522
Name:GODWIN, LAURA CHARLENE (APN)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:CHARLENE
Last Name:GODWIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SAUNDERSVILLE RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8903
Mailing Address - Country:US
Mailing Address - Phone:615-348-6231
Mailing Address - Fax:
Practice Address - Street 1:2175 CHAMBLISS AVE NW
Practice Address - Street 2:STE D
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3842
Practice Address - Country:US
Practice Address - Phone:423-472-1140
Practice Address - Fax:423-339-2242
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013203363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507955Medicaid
TN103I507625Medicare PIN