Healthcare Provider Details

I. General information

NPI: 1588579346
Provider Name (Legal Business Name): TARRAH BROCK MSN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6610 SE QUAKERVALE RD
RIVERTON KS
66770-4185
US

IV. Provider business mailing address

PO BOX 550
RIVERTON KS
66770-0550
US

V. Phone/Fax

Practice location:
  • Phone: 620-848-2300
  • Fax: 620-848-2301
Mailing address:
  • Phone: 620-848-2300
  • Fax: 620-848-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-86028-031
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: