Provider Demographics
NPI:1780731646
Name:GODWIN, KRISTALYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTALYNNE
Middle Name:
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 GEMINI ST STE 128
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2738
Mailing Address - Country:US
Mailing Address - Phone:281-218-9515
Mailing Address - Fax:
Practice Address - Street 1:1002 GEMINI ST STE 128
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2746
Practice Address - Country:US
Practice Address - Phone:281-218-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000043524207L00000X, 207LP3000X
TXN8920207L00000X, 207LP3000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program