Provider Demographics
NPI:1669775425
Name:CHAFFIN, DOLLY K (NP)
Entity type:Individual
Prefix:
First Name:DOLLY
Middle Name:K
Last Name:CHAFFIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 PENNSYLVANIA AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2191
Mailing Address - Country:US
Mailing Address - Phone:817-250-7240
Mailing Address - Fax:888-977-1985
Practice Address - Street 1:1325 PENNSYLVANIA AVE STE 450
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2191
Practice Address - Country:US
Practice Address - Phone:817-250-7240
Practice Address - Fax:888-977-1985
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX563286363L00000X
TXAP119369363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB141926Medicare PIN