Provider Demographics
NPI:1689287369
Name:DODSON, ANJELICA
Entity Type:Individual
Prefix:
First Name:ANJELICA
Middle Name:
Last Name:DODSON
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 1:301 N PRESTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8876
Mailing Address - Country:US
Mailing Address - Phone:972-347-1320
Mailing Address - Fax:972-347-1322
Practice Address - Street 1:301 N PRESTON RD STE B
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8876
Practice Address - Country:US
Practice Address - Phone:972-347-1320
Practice Address - Fax:972-347-1322
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF07190953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily