Provider Demographics
NPI:1568882348
Name:DOZIER, KATHY
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:DOZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EAGLES NEST OUTREACH
Other - Middle Name:
Other - Last Name:MINISTRY, LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:517 GLENROCK RD
Mailing Address - Street 2:APT B
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3805
Mailing Address - Country:US
Mailing Address - Phone:757-275-5902
Mailing Address - Fax:757-461-1059
Practice Address - Street 1:517 GLENROCK RD
Practice Address - Street 2:APT B
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3805
Practice Address - Country:US
Practice Address - Phone:757-275-5902
Practice Address - Fax:757-461-1059
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS4523702251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health