Basic Information
| Provider Information | |||||||||
| NPI: | 1174154652 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DODSON | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 787 | ||||||||
| Address2: | |||||||||
| City: | SALTILLO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388660787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623978651 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4250 S EASON BLVD | ||||||||
| Address2: | |||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388016549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623775265 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2020 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA00475 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.