Provider Demographics
NPI:1265559579
Name:SOCKYMA, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:SOCKYMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:KYKOTSMOVI
Mailing Address - State:AZ
Mailing Address - Zip Code:86039-0013
Mailing Address - Country:US
Mailing Address - Phone:928-734-0250
Mailing Address - Fax:
Practice Address - Street 1:ONE EIGHTH OF A MILE FROM JCT HWY 264 IN KYKOTSMOVI
Practice Address - Street 2:VILLAGE ROCK HOUSE BY MENONITE CHURCH
Practice Address - City:KYKOTSMOVI
Practice Address - State:AZ
Practice Address - Zip Code:86039
Practice Address - Country:US
Practice Address - Phone:928-734-6614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ151987Medicaid