Provider Demographics
NPI:1841710977
Name:DOTSON, KINA (LPN, CWC)
Entity type:Individual
Prefix:
First Name:KINA
Middle Name:
Last Name:DOTSON
Suffix:
Gender:F
Credentials:LPN, CWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4189 MEDFORD DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4517
Mailing Address - Country:US
Mailing Address - Phone:614-657-1131
Mailing Address - Fax:
Practice Address - Street 1:2622 DALE EARNHARDT BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-1401
Practice Address - Country:US
Practice Address - Phone:614-657-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84812164W00000X
174H00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No164W00000XNursing Service ProvidersLicensed Practical Nurse