Healthcare Provider Details

I. General information

NPI: 1033123781
Provider Name (Legal Business Name): KAREN BROCK CNM WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/27/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 MEDICAL CENTER BLVD STE 320
CONROE TX
77304-2845
US

IV. Provider business mailing address

508 MEDICAL CENTER BLVD STE 320
CONROE TX
77304-2845
US

V. Phone/Fax

Practice location:
  • Phone: 936-523-5790
  • Fax: 936-760-4612
Mailing address:
  • Phone: 936-523-5790
  • Fax: 936-760-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number516186
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number516186
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: