Provider Demographics
NPI:1316384332
Name:DOOLEY, DALLAS W (APRN-C)
Entity Type:Individual
Prefix:MR
First Name:DALLAS
Middle Name:W
Last Name:DOOLEY
Suffix:
Gender:M
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 COLUMBINE DR
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436
Mailing Address - Country:US
Mailing Address - Phone:785-364-2116
Mailing Address - Fax:785-364-9620
Practice Address - Street 1:620 W 8TH ST
Practice Address - Street 2:
Practice Address - City:KINSLEY
Practice Address - State:KS
Practice Address - Zip Code:67547-2329
Practice Address - Country:US
Practice Address - Phone:620-659-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13103826021163WE0003X
KS76124363L00000X
KS53-76124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner