Provider Demographics
NPI:1043798713
Name:DOTSON, TURKESA HENDERSON (APRN)
Entity Type:Individual
Prefix:
First Name:TURKESA
Middle Name:HENDERSON
Last Name:DOTSON
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 1:6956 HWY 190 W
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-4754
Mailing Address - Country:US
Mailing Address - Phone:225-692-9007
Mailing Address - Fax:
Practice Address - Street 1:6956 HWY 190 W
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-4754
Practice Address - Country:US
Practice Address - Phone:225-692-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA007148382OtherDRIVER'S LICENSE