Provider Demographics
NPI:1114159068
Name:DODD, KAMARA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:KAMARA
Middle Name:MARIE
Last Name:DODD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 RAY LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2466
Mailing Address - Country:US
Mailing Address - Phone:541-404-4481
Mailing Address - Fax:541-225-4884
Practice Address - Street 1:644 RAY LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2466
Practice Address - Country:US
Practice Address - Phone:541-404-4485
Practice Address - Fax:541-225-4884
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN1836363LF0000X
OR200950101NP FNP-PP363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR161133OtherGROUP MEDICAID
ORR0000WFBTVOtherGROUP MEDICARE
OR1407812365OtherGROUP NPI
OR500611143Medicaid