Healthcare Provider Details

I. General information

NPI: 1033587662
Provider Name (Legal Business Name): CONNIE DOCKREY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W INDEPENDENCE ST STE 116
SHAWNEE OK
74804-4329
US

IV. Provider business mailing address

15709 CROSSLIN RD
SHAWNEE OK
74801-9781
US

V. Phone/Fax

Practice location:
  • Phone: 405-250-5313
  • Fax:
Mailing address:
  • Phone: 405-250-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: