Individual provider Active NPI

Dolly K. Chaffin, NP

  • Acute Care Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1669775425
Registry record updated Sep 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP119369 Issued in TX
Practice address
1325 Pennsylvania Ave Ste 450
Fort Worth, TX 76104-2191
Phone
(817) 250-7240
Fax
(888) 977-1985
NPI assigned
Dec 15, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 563286 TX
Acute Care Nurse Practitioner 363LA2100X AP119369 TX Primary

Addresses

Primary practice location

1325 Pennsylvania Ave Ste 450
Fort Worth, TX 76104-2191

Mailing address

1325 Pennsylvania Ave Ste 450
Fort Worth, TX 76104-2191
Phone (817) 250-7240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP119369TXMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alamo City Medical Group, PLLC PastSince Apr 1, 2013 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569283200000",
    "number": "1669775425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 PENNSYLVANIA AVE STE 450",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042191",
            "telephone_number": "817-250-7240",
            "fax_number": "888-977-1985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 PENNSYLVANIA AVE STE 450",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042191",
            "telephone_number": "817-250-7240",
            "fax_number": "888-977-1985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAFFIN",
        "first_name": "DOLLY",
        "middle_name": "K.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-15",
        "last_updated": "2019-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "563286",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP119369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.