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General NPI Number Information
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NPI Number | 1962068981
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Entity Type | Individual
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Provider Name | JACQUELYNN DORMAN FNP
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Gender | Female
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 1330 E 8TH ST STE 414
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City | ODESSA
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State | TX
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Zip | 79761-4733
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Country | US
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Telephone | 432-614-2176
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Fax | 432-614-0876
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Provider Business Mailing Address
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Address Line | 6509 MOSSWOOD DR
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City | MIDLAND
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State | TX
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Zip | 79707-5075
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Country | US
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Telephone | 432-978-3022
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Fax | 432-614-0876
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | AP140013
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP140013
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License Number State | TX
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