Provider Demographics
NPI:1912406661
Name:MADKINS, DAWN M (RN, MSN, A-GNP-C)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:MADKINS
Suffix:
Gender:F
Credentials:RN, MSN, A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402
Mailing Address - Country:US
Mailing Address - Phone:903-455-3500
Mailing Address - Fax:903-455-3509
Practice Address - Street 1:5005 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402
Practice Address - Country:US
Practice Address - Phone:903-455-3500
Practice Address - Fax:903-455-3509
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136493363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner