Provider Demographics
NPI:1801654520
Name:BROCK, CATHERINE ELIZABETH (MSN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:BROCK
Suffix:
Gender:F
Credentials:MSN, CPNP-PC
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 566
Mailing Address - Street 2:
Mailing Address - City:SUMRALL
Mailing Address - State:MS
Mailing Address - Zip Code:39482-0566
Mailing Address - Country:US
Mailing Address - Phone:601-336-9099
Mailing Address - Fax:601-550-6184
Practice Address - Street 1:4881 HWY 589
Practice Address - Street 2:
Practice Address - City:SUMRALL
Practice Address - State:MS
Practice Address - Zip Code:39482-3948
Practice Address - Country:US
Practice Address - Phone:601-336-9099
Practice Address - Fax:601-550-6184
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906028363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics