Healthcare Provider Details

I. General information

NPI: 1386652873
Provider Name (Legal Business Name): CHRIS MCCLAIN ROCKEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HARTFORD ST
LAFAYETTE IN
47904-2134
US

IV. Provider business mailing address

1971 NORTHAMPTON DR
KOKOMO IN
46902-1844
US

V. Phone/Fax

Practice location:
  • Phone: 765-423-6011
  • Fax: 260-407-8004
Mailing address:
  • Phone: 317-439-3311
  • Fax: 260-407-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number10000591A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000591A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: