Provider Demographics
NPI:1205549540
Name:DOGGETT, KAELEA MAE (CPHT)
Entity type:Individual
Prefix:MS
First Name:KAELEA
Middle Name:MAE
Last Name:DOGGETT
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17460 IH 35 N STE 500
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1207
Mailing Address - Country:US
Mailing Address - Phone:210-651-4148
Mailing Address - Fax:
Practice Address - Street 1:17460 IH 35 N STE 500
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1207
Practice Address - Country:US
Practice Address - Phone:210-651-4148
Practice Address - Fax:210-651-1643
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX285394183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician