Provider Demographics
NPI:1427036417
Name:BRACKEEN, AMY ROCKY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ROCKY
Last Name:BRACKEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4709 66TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-4877
Mailing Address - Country:US
Mailing Address - Phone:806-701-5844
Mailing Address - Fax:806-701-5845
Practice Address - Street 1:4709 66TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-4877
Practice Address - Country:US
Practice Address - Phone:806-701-5844
Practice Address - Fax:806-701-5845
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9108207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88220NMedicare PIN