Provider Demographics
NPI:1457476624
Name:DOCKENEY, MERCEDES L (CRNA)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:L
Last Name:DOCKENEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:L
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:70 BRIGHT CHERRY CT
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-7302
Mailing Address - Country:US
Mailing Address - Phone:304-283-4758
Mailing Address - Fax:
Practice Address - Street 1:1006 TAVERN RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2864
Practice Address - Country:US
Practice Address - Phone:304-267-0556
Practice Address - Fax:304-267-1460
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002386367500000X
VA0001204998367500000X
WV60274367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010071Medicaid
VA014033W68Medicare PIN