Provider Demographics
NPI:1669980744
Name:DAWSON, KEVIN MICHAEL
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MICHAEL
Last Name:DAWSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13616 WACO AVENUE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423
Mailing Address - Country:US
Mailing Address - Phone:903-240-0756
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH ST # MS 8182
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-2981
Practice Address - Fax:806-743-2984
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136745367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered