Provider Demographics
NPI:1649240706
Name:GODWIN, KATHERINE L (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:L
Other - Last Name:PROPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPARTMENT 31
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-502-5041
Mailing Address - Fax:918-502-5060
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-502-5041
Practice Address - Fax:918-502-5060
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK243392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
7153715OtherAETNA BEHAVIORAL HEALTH
OK200058480AMedicaid
2226324OtherCIGNA BEHAVIORAL HEALTH
OK243524103Medicare PIN
OK200058480AMedicaid