Provider Demographics
NPI:1144206780
Name:DODSON, LINDA SUE (APRN CNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUE
Last Name:DODSON
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 E CLARK BASS BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4283
Mailing Address - Country:US
Mailing Address - Phone:918-421-6960
Mailing Address - Fax:918-421-6963
Practice Address - Street 1:3 E CLARK BASS BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4283
Practice Address - Country:US
Practice Address - Phone:918-421-6960
Practice Address - Fax:918-421-6963
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX544241363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611851Medicare ID - Type Unspecified
OKOK404200Medicare PIN
TXQ47512Medicare UPIN