Provider Demographics
NPI:1376587121
Name:DOLMAN, KATHERINE D (MSN, ACNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:DOLMAN
Suffix:
Gender:F
Credentials:MSN, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1228
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75021-1228
Mailing Address - Country:US
Mailing Address - Phone:903-718-0913
Mailing Address - Fax:972-625-7064
Practice Address - Street 1:1000 SARA SWAMY DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-3112
Practice Address - Country:US
Practice Address - Phone:903-718-0913
Practice Address - Fax:972-625-7064
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX508052363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y0638OtherBLUE CROSS BLUE SHIELD
TX1760514-01Medicaid
TX8Y0639OtherBLUE CROSS BLUE SHIELD
TXNP7265OtherBLUE CROSS/BLUE SHIELD
TXNP0435Medicare PIN
TXNP7265OtherBLUE CROSS/BLUE SHIELD
TX1760514-01Medicaid
TXP00441554Medicare PIN
TX8Y0638OtherBLUE CROSS BLUE SHIELD
TX8D9397Medicare ID - Type UnspecifiedMEDICARE
TXP00666274Medicare PIN