Provider Demographics
NPI:1518962299
Name:GODSEY, NINA PARTIN (PA-C)
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:PARTIN
Last Name:GODSEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:NINA
Other - Middle Name:BETH
Other - Last Name:PARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6431 FANNIN ST STE 6.234
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-7401
Mailing Address - Fax:713-500-0785
Practice Address - Street 1:6411 FANNIN ST STE J1-400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-704-4071
Practice Address - Fax:713-704-4813
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02296363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338914001Medicaid
TX00998ROtherMEDICARE DAHGRP#
TX148009701Medicaid
TX752616977008OtherTRICARE
TX866ONJOtherBCBS
TXS67637Medicare UPIN
TXP01380848Medicare Oscar/Certification
TX338914001Medicaid