MS. BEATRICE LEE GODBOULDT PA-C NPI 1457406241

NPI Information

NPI: 1457406241
Provider Name: MS. BEATRICE LEE GODBOULDT, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
821 N NELLIS BLVD
LAS VEGAS, NV
ZIP 89110
Phone: (702) 438-4003
Get Directions

MS. Beatrice Lee Godbouldt, PA-C is a medical physician assistant in Las Vegas, NV. MS. Beatrice Lee Godbouldt, PA-C NPI is 1457406241. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

821 N NELLIS BLVD
LAS VEGAS, NV
ZIP 89110-339
Phone: (702) 438-4003
Fax: (702) 438-0555

The NPI 1457406241 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/24/2007 and was last updated on 3/17/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207P00000X	Emergency Medicine		PA12936	CALIFORNIA	No
2	363A00000X	Physician Assistant		PA12936	CALIFORNIA	No
3	363AM0700X	Physician Assistant	Medical	PA1710	NEVADA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	W809A	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA	ROYBAL
2	W809B	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA	HUDSON
3	1457406241	MEDICAID	NEVADA
4	W809F	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA	EL MONTE
5	PENDING	MEDICARE PIN	NEVADA
6	W932	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA	HEALTH CENTER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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