Provider Demographics
NPI:1417422957
Name:DORSEY, EBONI CHARMELE (FNP-C)
Entity Type:Individual
Prefix:
First Name:EBONI
Middle Name:CHARMELE
Last Name:DORSEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 DIAMONDBACK
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-5172
Mailing Address - Country:US
Mailing Address - Phone:409-673-1643
Mailing Address - Fax:
Practice Address - Street 1:7125 MARVIN D LOVE FWY STE 107
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3111
Practice Address - Country:US
Practice Address - Phone:972-332-5029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily