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General NPI Number Information
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NPI Number | 1447600333
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Entity Type | Individual
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Provider Name | CRISSIE ALAYNE BROCK P.A.- C
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Gender | Female
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 2800 VILLAGE RD # 108
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City | GRANBURY
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State | TX
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Zip | 76049-4193
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Country | US
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Telephone | 817-573-0444
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Fax |
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Provider Business Mailing Address
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Address Line | 930 SE 4TH ST
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City | GRAND PRAIRIE
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State | TX
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Zip | 75051-3221
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Country | US
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Telephone | 817-271-7425
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | TX
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