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General NPI Number Information
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NPI Number | 1194523324
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Entity Type | Organization
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Legal Business Name | D O T PIT STOP
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 209 E PEARL ST
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City | ODESSA
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State | TX
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Zip | 79761-5500
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Country | US
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Telephone | 432-967-0557
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Fax |
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Provider Business Mailing Address
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Address Line | 209 E PEARL ST
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City | ODESSA
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State | TX
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Zip | 79761-5500
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Country | US
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Telephone | 432-967-0557
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TASHAWNDA PATTERSON
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Credential | FNP
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Telephone | 432-352-5627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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