Healthcare Provider Details

I. General information

NPI: 1780191635
Provider Name (Legal Business Name): ALEX R DODSON PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2018
Last Update Date: 01/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 MIRA LOMA LN STE 102
AUSTIN TX
78723-1411
US

IV. Provider business mailing address

7005 MIRA LOMA LN STE 102
AUSTIN TX
78723-1411
US

V. Phone/Fax

Practice location:
  • Phone: 512-795-4344
  • Fax:
Mailing address:
  • Phone: 512-795-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP136118
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: