Provider Demographics
NPI:1649002619
Name:DODSON, KAILEY CLAIRE MATACONIS (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:CLAIRE MATACONIS
Last Name:DODSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 HOSPITAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-1905
Mailing Address - Country:US
Mailing Address - Phone:318-212-7841
Mailing Address - Fax:318-212-7846
Practice Address - Street 1:2449 HOSPITAL DR STE 200
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-1905
Practice Address - Country:US
Practice Address - Phone:318-212-7841
Practice Address - Fax:318-212-7846
Is Sole Proprietor?:No
Enumeration Date:2024-08-17
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA210588363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner