Provider Demographics
NPI:1740471168
Name:DOTSON, JESSIE MAE (APN-C)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:MAE
Last Name:DOTSON
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 314
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-963-6770
Practice Address - Fax:856-968-8240
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC09517300364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010045943OtherAMERICHOICE
NJ0143421Medicaid
NJ60035460OtherHORIZON NJ HEALTH
NJ3K6159OtherHEALTHNET, INC
NJ0143421Medicaid