Healthcare Provider Details

I. General information

NPI: 1790977395
Provider Name (Legal Business Name): LESLIEANN DANIELLE DOTSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 WILLOW DR
AUXIER KY
41602-9259
US

IV. Provider business mailing address

1709 KY ROUTE 321 STE 3
PRESTONSBURG KY
41653-9097
US

V. Phone/Fax

Practice location:
  • Phone: 606-886-8997
  • Fax:
Mailing address:
  • Phone: 606-886-8546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number03269
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: