Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mrs. Kelly Ann Godberson, NP

Individual provider Nurse Practitioner · NPI 1053833962

Mrs. Kelly Ann Godberson, NP is a Nurse Practitioner in Medford, New York. Qualified in 2017, 9 years ago. Practices as a sole proprietor. Licensed in New York.

Years since qualifying
9
Licensed in
NY
In the registry since
2017
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

3115 Horseblock Rd
Medford, NY 11763-2526
Phone: (631) 730-3000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 308240 (NY)

Record details

NPI number1053833962
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorYes
NPI enumeratedJuly 12, 2017
Last updated in NPPESJuly 12, 2017

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Accepts Medicare assignment Not indicated

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