Healthcare Provider Details

I. General information

NPI: 1134182637
Provider Name (Legal Business Name): CAROL A. DODSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 SUNSET AVE
KILL DEVIL HILLS NC
27948-9353
US

IV. Provider business mailing address

1804 SUNSET AVE
KILL DEVIL HILLS NC
27948-9353
US

V. Phone/Fax

Practice location:
  • Phone: 540-729-9270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024165127
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5004862
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: