Provider Demographics
NPI:1215785464
Name:DODSON, SKY (NRCPT, NRCMA)
Entity type:Individual
Prefix:
First Name:SKY
Middle Name:
Last Name:DODSON
Suffix:
Gender:F
Credentials:NRCPT, NRCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 BECK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-2500
Mailing Address - Country:US
Mailing Address - Phone:972-948-3072
Mailing Address - Fax:972-767-3970
Practice Address - Street 1:626 BECK AVE
Practice Address - Street 2:
Practice Address - City:LAKE DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75065-2500
Practice Address - Country:US
Practice Address - Phone:972-948-3072
Practice Address - Fax:973-276-7397
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94934246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy