Individual
JESSICA C BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4423 BARDSTOWN RD, LOUISVILLE, KY 40218-3235
(502) 749-7909
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1089287
NCCPA
KY
Enumeration date
05/28/2010
Last updated
11/23/2021
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