Basic Information
Provider Information
NPI: 1144972035
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DORSETT
FirstName: SANDRA
MiddleName: KAY
NamePrefix: MS.
NameSuffix:  
Credential: APRN FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5219 CITY BANK PKWY STE 35
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794073545
CountryCode: US
TelephoneNumber: 8067610334
FaxNumber: 8067850872
Practice Location
Address1: 7501 QUAKER AVE FL 1
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794243367
CountryCode: US
TelephoneNumber: 8067883306
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/21/2022
LastUpdateDate: 03/02/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/02/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X1061479TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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