Provider Demographics
NPI:1942897053
Name:DOTSON, KATIE KRISTINA
Entity Type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:KRISTINA
Last Name:DOTSON
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 1:122 SUMMIT OAK LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-5979
Mailing Address - Country:US
Mailing Address - Phone:304-695-0072
Mailing Address - Fax:
Practice Address - Street 1:89 WILKINSON ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-5953
Practice Address - Country:US
Practice Address - Phone:304-695-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant