Healthcare Provider Details

I. General information

NPI: 1598800013
Provider Name (Legal Business Name): ANDREA DOSSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HILLCREST MEDICAL BLVD
WACO TX
76712-8897
US

IV. Provider business mailing address

PO BOX 848891
DALLAS TX
75284-8491
US

V. Phone/Fax

Practice location:
  • Phone: 254-202-2000
  • Fax: 254-202-5651
Mailing address:
  • Phone: 254-202-9330
  • Fax: 254-202-9349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP113456
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number652411
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: