Basic Information
| Provider Information | |||||||||
| NPI: | 1871997114 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOBBINS | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4730 COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763844009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405529901 | ||||||||
| FaxNumber: | 9405532523 | ||||||||
| Practice Location | |||||||||
| Address1: | 4730 COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763844009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405529901 | ||||||||
| FaxNumber: | 9405532523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2014 | ||||||||
| LastUpdateDate: | 10/24/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP126603 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | MD3345988 | 01 | DEA | OTHER | S0211228 | 01 | TX | DEPARTMENT OF PUBLIC SAFETY | OTHER |