Healthcare Provider Details

I. General information

NPI: 1922932102
Provider Name (Legal Business Name): EMILY SUE BOCK AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 HOSPITAL DR
HANNIBAL MO
63401-6890
US

IV. Provider business mailing address

6500 HOSPITAL DR
HANNIBAL MO
63401-6890
US

V. Phone/Fax

Practice location:
  • Phone: 573-629-3500
  • Fax:
Mailing address:
  • Phone: 573-629-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2026011789
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2026011789
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2026011789
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: