Healthcare Provider Details

I. General information

NPI: 1316384332
Provider Name (Legal Business Name): DALLAS W DOOLEY APRN-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W 8TH ST
KINSLEY KS
67547-2329
US

IV. Provider business mailing address

1100 COLUMBINE DR
HOLTON KS
66436
US

V. Phone/Fax

Practice location:
  • Phone: 620-659-3621
  • Fax:
Mailing address:
  • Phone: 785-364-2116
  • Fax: 785-364-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number76124
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76124
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number13103826021
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: