Healthcare Provider Details

I. General information

NPI: 1689814337
Provider Name (Legal Business Name): MACHELLE M DOTSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 GRAND VIEW DR
LYLE WA
98635-9638
US

IV. Provider business mailing address

64 GRAND VIEW DR
LYLE WA
98635-9638
US

V. Phone/Fax

Practice location:
  • Phone: 509-509-8794
  • Fax: 509-923-8262
Mailing address:
  • Phone: 509-493-2133
  • Fax: 509-923-8262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60095040
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA01434
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: