Provider Demographics
NPI:1225613862
Name:DOLEZAL, KATE
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:DOLEZAL
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 1:6306 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-4801
Mailing Address - Country:US
Mailing Address - Phone:806-626-8606
Mailing Address - Fax:
Practice Address - Street 1:11 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4137
Practice Address - Country:US
Practice Address - Phone:806-355-9355
Practice Address - Fax:806-340-7975
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1031602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily