Provider Demographics
NPI:1851045611
Name:GODWIN, KIM RENA
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:RENA
Last Name:GODWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 25TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1212
Mailing Address - Country:US
Mailing Address - Phone:757-937-5991
Mailing Address - Fax:757-937-9118
Practice Address - Street 1:600 W 25TH ST STE 6
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1212
Practice Address - Country:US
Practice Address - Phone:757-937-5991
Practice Address - Fax:757-937-9118
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health