Provider Demographics
NPI:1619860202
Name:DODSON, KRISTY D (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:D
Last Name:DODSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 SPARKMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:DOYLE
Mailing Address - State:TN
Mailing Address - Zip Code:38559-3207
Mailing Address - Country:US
Mailing Address - Phone:931-743-3130
Mailing Address - Fax:
Practice Address - Street 1:705 HOWELL ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1057
Practice Address - Country:US
Practice Address - Phone:931-739-0048
Practice Address - Fax:931-739-0047
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN165966363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner