Provider Demographics
NPI:1720072887
Name:DOCKINS, SAUNDRA L (CRNA)
Entity Type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:L
Last Name:DOCKINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SAUNDRA
Other - Middle Name:L
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-587-4799
Mailing Address - Fax:502-540-3730
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1882
Practice Address - Country:US
Practice Address - Phone:502-587-4799
Practice Address - Fax:502-540-3730
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1023116163W00000X
IN28155731A163W00000X
KY3000418367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200897090AMedicaid
KY7432288400Medicaid
KYP00805573Medicare PIN
IN200897090AMedicaid