Provider Demographics
NPI:1992842595
Name:DOCKERY, VERONICA G (PA)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:G
Last Name:DOCKERY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-1865
Mailing Address - Country:US
Mailing Address - Phone:479-966-5088
Mailing Address - Fax:479-752-3235
Practice Address - Street 1:767 W NORTH ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-1865
Practice Address - Country:US
Practice Address - Phone:479-966-5088
Practice Address - Fax:479-282-0469
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003467363AM0700X
ARPA-344363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPA-344OtherSTATE LICENSE
ARPA-344OtherSTATE LICENSE
MDPA61721OtherCDS
ARPA-344OtherSTATE LICENSE