Provider Demographics
NPI:1528045085
Name:GODBY, BECKY L (ARNP)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:L
Last Name:GODBY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S STILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3578
Mailing Address - Country:US
Mailing Address - Phone:360-683-2388
Mailing Address - Fax:360-504-3666
Practice Address - Street 1:502 S STILL RD STE 102
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382
Practice Address - Country:US
Practice Address - Phone:360-683-2388
Practice Address - Fax:360-504-3666
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60528556363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR49285Medicare UPIN
442784173Medicare PIN