Individual
NELL CATHERINE BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP,C
Contact information
Practice address
108 VFW RD, GRENADA, MS 38901
(662) 226-6920
(662) 226-6920
Mailing address
108 VFW RD, PO BOX 1112, GRENADA, MS 38902
(662) 226-6920
(662) 226-6920
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R604526
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019532
—
MS
Enumeration date
07/15/2005
Last updated
11/27/2019
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