Provider Demographics
NPI:1295194447
Name:GODDARD, LAUREN (CRNP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GODDARD
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 TUSCALOOSA ST STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:36744-1562
Mailing Address - Country:US
Mailing Address - Phone:334-218-0160
Mailing Address - Fax:334-212-0131
Practice Address - Street 1:850 TUSCALOOSA ST STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-1562
Practice Address - Country:US
Practice Address - Phone:334-218-0160
Practice Address - Fax:334-212-0131
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-133873363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner