Provider Demographics
NPI:1780787077
Name:GODSEY, JILL ANN (APN,CNS)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:GODSEY
Suffix:
Gender:F
Credentials:APN,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N BUCKBOARD DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-1807
Mailing Address - Country:US
Mailing Address - Phone:830-792-2451
Mailing Address - Fax:830-792-2423
Practice Address - Street 1:3600 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5768
Practice Address - Country:US
Practice Address - Phone:830-792-2451
Practice Address - Fax:830-792-2423
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74270364SP0808X
TX657184364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health