1184744021 NPI number — MS. ROSALIND ELAINE DOCKERY I ADMINISTRATOR

Table of content: MS. ROSALIND ELAINE DOCKERY I ADMINISTRATOR (NPI 1184744021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184744021 NPI number — MS. ROSALIND ELAINE DOCKERY I ADMINISTRATOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOCKERY
Provider First Name:
ROSALIND
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
I
Provider Credential Text:
ADMINISTRATOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REECE
Provider Other First Name:
ROSALIND
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
ADMINISTRATOR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184744021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 MOORE ST
Provider Second Line Business Mailing Address:
288 6TH. ST.
Provider Business Mailing Address City Name:
ANDREWS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28901-9633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-321-9501
Provider Business Mailing Address Fax Number:
828-321-9501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 MOORE ST
Provider Second Line Business Practice Location Address:
288 6TH. ST.
Provider Business Practice Location Address City Name:
ANDREWS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28901-9633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-321-9501
Provider Business Practice Location Address Fax Number:
828-321-9501
Provider Enumeration Date:
03/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 376G00000X , with the licence number:  FCL-020-010 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7803440 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7804207 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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