Provider Demographics
NPI:1215093539
Name:ROCKETT, SEAN DALE (PA-C)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:DALE
Last Name:ROCKETT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 S CIRCLE DR STE 109
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4195
Mailing Address - Country:US
Mailing Address - Phone:888-374-5066
Mailing Address - Fax:719-623-0165
Practice Address - Street 1:3351 EASTBROOK DR STE 200
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5744
Practice Address - Country:US
Practice Address - Phone:888-374-5066
Practice Address - Fax:719-623-0165
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05097363A00000X, 363AM0700X
COPA.0005304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX316837902Medicaid
TX382309YL9JMedicare PIN