Provider Demographics
NPI:1033585799
Name:ROCKETT, ROLLIE (RN, MSN, CPNP)
Entity Type:Individual
Prefix:MR
First Name:ROLLIE
Middle Name:
Last Name:ROCKETT
Suffix:
Gender:M
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S FLORES ST APT 103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-1650
Mailing Address - Country:US
Mailing Address - Phone:574-849-0911
Mailing Address - Fax:
Practice Address - Street 1:1401 S FLORES ST APT 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78204-1650
Practice Address - Country:US
Practice Address - Phone:574-849-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127035363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics