Provider Demographics
NPI:1154324697
Name:DAWSON, KATHLEEN ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:DAWSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-6640
Mailing Address - Country:US
Mailing Address - Phone:432-213-8951
Mailing Address - Fax:
Practice Address - Street 1:1601 W 11TH PL
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4114
Practice Address - Country:US
Practice Address - Phone:432-263-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX762365367500000X
OHRN161125163W00000X
PARN264871L163W00000X
SCAPN2170367500000X
OHNA04591367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8753UAOtherBCBS
TX206155803Medicaid
TX206155803Medicaid