Provider Demographics
NPI:1003393778
Name:DODD, KANDRA (APRN)
Entity Type:Individual
Prefix:
First Name:KANDRA
Middle Name:
Last Name:DODD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:KENEFIC
Mailing Address - State:OK
Mailing Address - Zip Code:74748-0092
Mailing Address - Country:US
Mailing Address - Phone:580-579-9947
Mailing Address - Fax:
Practice Address - Street 1:511 E CHOCTAW AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5031
Practice Address - Country:US
Practice Address - Phone:580-579-9947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK80748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily