Provider Demographics
NPI:1326686684
Name:DOTSON, KELLEY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:ANN
Last Name:DOTSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KENTON DR STE 2
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1266
Mailing Address - Country:US
Mailing Address - Phone:304-345-1966
Mailing Address - Fax:304-345-1978
Practice Address - Street 1:300 KENTON DR STE 2
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1266
Practice Address - Country:US
Practice Address - Phone:304-345-1966
Practice Address - Fax:304-345-1978
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2383363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant