Provider Demographics
NPI:1083214803
Name:DOTSON, CHRISSY LEEANN
Entity Type:Individual
Prefix:
First Name:CHRISSY
Middle Name:LEEANN
Last Name:DOTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:WV
Mailing Address - Zip Code:25625
Mailing Address - Country:US
Mailing Address - Phone:304-687-1861
Mailing Address - Fax:
Practice Address - Street 1:419 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:WV
Practice Address - Zip Code:25625
Practice Address - Country:US
Practice Address - Phone:304-687-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant