Provider Demographics
NPI:1801197785
Name:DODDY, ANGELA (CFNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DODDY
Suffix:
Gender:F
Credentials:CFNP
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 1367
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75483-1367
Mailing Address - Country:US
Mailing Address - Phone:903-885-3181
Mailing Address - Fax:903-885-1329
Practice Address - Street 1:105 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2136
Practice Address - Country:US
Practice Address - Phone:903-885-3181
Practice Address - Fax:903-885-1329
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX678107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330935301Medicaid
TX330935301Medicaid