Individual provider Active NPI

Abby Nicole Godwin, CRNA

  • Certified Registered Nurse Anesthetist
  • Tyler, TX
National Provider Identifier
1316278971
Registry record updated Jan 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
083721 Issued in TX
Practice address
1000 S Beckham Ave
Tyler, TX 75701-1908
Phone
(903) 531-8638
Fax
(817) 877-0350
NPI assigned
Jan 21, 2010
Last updated
Jan 21, 2010By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 21, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 083721 TX Primary

Addresses

Primary practice location

1000 S Beckham Ave
Tyler, TX 75701-1908

Mailing address

1000 S Beckham Ave
Tyler, TX 75701-1908
Phone (903) 531-8638

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100306000347 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 9638214299 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

700 E Marshall Ave
Longview, TX 75601-5580
Phone (903) 315-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
083721TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Good Shepherd Medical Center CurrentSince Dec 26, 2017 Accepting new patients
Emergenchealth PLLC Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2022 Accepting new patients
Christus Good Shepherd Medical Center Nurse Anesthetist, Certified Registered CurrentSince Dec 26, 2017 Accepting new patients

Locations

2000 S Palestine St
Athens, TX 75751
Phone (903) 675-2216

409 Cottage Rd
Carthage, TX 75633
Phone (903) 693-3841

700 E Marshall Ave
Longview, TX 75601
Phone (903) 236-2000

811 S Washington Ave
Marshall, TX 75670
Phone (903) 315-1488

7400 Barlite Blvd
San Antonio, TX 78224
Phone (210) 921-2000

1000 S Beckham Ave
Tyler, TX 75701
Phone (903) 526-1068

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264032000000",
    "number": "1316278971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 S BECKHAM AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011908",
            "telephone_number": "903-531-8638",
            "fax_number": "817-877-0350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S BECKHAM AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011908",
            "telephone_number": "903-531-8638",
            "fax_number": "817-877-0350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODWIN",
        "first_name": "ABBY",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-21",
        "last_updated": "2010-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "083721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.