Provider Demographics
NPI:1669824470
Name:DODGE, KAREN J (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:DODGE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:DODGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3200 COLORADO BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6876
Mailing Address - Country:US
Mailing Address - Phone:940-600-5311
Mailing Address - Fax:888-494-2325
Practice Address - Street 1:3200 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6874
Practice Address - Country:US
Practice Address - Phone:940-600-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1129641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicaid
MOPENDINGMedicare PIN