Provider Demographics
NPI:1740959089
Name:DOTSON, THERESA ALLISON (NP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ALLISON
Last Name:DOTSON
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 1:5542 WIPLEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-2654
Mailing Address - Country:US
Mailing Address - Phone:540-589-0791
Mailing Address - Fax:
Practice Address - Street 1:202 DUKE GLOUCESTER ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1372
Practice Address - Country:US
Practice Address - Phone:540-345-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182656363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner