Provider Demographics
NPI:1821642760
Name:DORSEY, KELLY NICOLE (AGACNP-BP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:DORSEY
Suffix:
Gender:F
Credentials:AGACNP-BP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:NICOLE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3917 WOODRUFF CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-4656
Mailing Address - Country:US
Mailing Address - Phone:713-398-2815
Mailing Address - Fax:
Practice Address - Street 1:621 N HALL ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1339
Practice Address - Country:US
Practice Address - Phone:713-398-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141024363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner