Provider Demographics
NPI:1730655671
Name:DOCKERY, MISTY DAWN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:DOCKERY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:DAWN
Other - Last Name:HOLBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:4485 W STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-1487
Practice Address - Country:US
Practice Address - Phone:423-578-8500
Practice Address - Fax:423-578-8590
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000024681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily