Provider Demographics
NPI:1023783123
Name:GODWIN, COURTANEY (LPN)
Entity type:Individual
Prefix:
First Name:COURTANEY
Middle Name:
Last Name:GODWIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 KNOXVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-3611
Mailing Address - Country:US
Mailing Address - Phone:865-242-2131
Mailing Address - Fax:
Practice Address - Street 1:5203 KNOXVILLE HWY
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-3611
Practice Address - Country:US
Practice Address - Phone:865-242-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58540164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse