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General NPI Number Information
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NPI Number | 1215491006
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Entity Type | Individual
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Provider Name | ALISHA ANN BROCK APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 11/24/2022
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Provider Practice Location Address
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Address Line | 4421 EMERSON AVE STE 205
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City | PARKERSBURG
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State | WV
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Zip | 26104-1200
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Country | US
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Telephone | 304-693-6096
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Fax |
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Provider Business Mailing Address
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Address Line | 2073 DUTCH RIDGE RD
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City | PARKERSBURG
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State | WV
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Zip | 26104-7020
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Country | US
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Telephone | 304-210-0061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN92399-NP-C
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License Number State | WV
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