Provider Demographics
NPI:1154936458
Name:DOTSON, KELLY A
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:DOTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 S COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-9129
Mailing Address - Country:US
Mailing Address - Phone:614-806-5005
Mailing Address - Fax:
Practice Address - Street 1:566 S COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-9129
Practice Address - Country:US
Practice Address - Phone:614-806-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251X00000XAgenciesSupports Brokerage