Provider Demographics
NPI:1316006232
Name:DOCKINS, SUSAN C (FNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:DOCKINS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10620 SOUTHERN HIGHLANDS PKWY STE 110-289
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-4371
Mailing Address - Country:US
Mailing Address - Phone:702-778-2204
Mailing Address - Fax:702-688-4371
Practice Address - Street 1:5380 S RAINBOW BLVD STE 236
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1879
Practice Address - Country:US
Practice Address - Phone:702-778-2204
Practice Address - Fax:702-688-4371
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV847226363LF0000X
AZAP2327363LF0000X
COAPN0992764NP363LF0000X
COC-APN.0000451-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13830074Medicaid
COP01607024OtherRAILROAD WORKES MEDICARE PTAN
CO474261ZPR5Medicare PIN