Provider Demographics
NPI:1821782806
Name:GODSEY, LAKOTA (PA-C)
Entity Type:Individual
Prefix:
First Name:LAKOTA
Middle Name:
Last Name:GODSEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9898 HANSON CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-9173
Mailing Address - Country:US
Mailing Address - Phone:812-278-4129
Mailing Address - Fax:
Practice Address - Street 1:2601 IRON GATE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6625
Practice Address - Country:US
Practice Address - Phone:910-500-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12911363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant