Provider Demographics
NPI:1912245044
Name:SPATES, DORETTA (ANP-C)
Entity Type:Individual
Prefix:
First Name:DORETTA
Middle Name:
Last Name:SPATES
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4434 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6442
Mailing Address - Country:US
Mailing Address - Phone:817-308-5442
Mailing Address - Fax:
Practice Address - Street 1:3246 PRESTON RD STE 620
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9077
Practice Address - Country:US
Practice Address - Phone:972-430-7477
Practice Address - Fax:972-767-3424
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX622642363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health