=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780527721
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. SARAH BROCK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2026
-----------------------------------------------------
Last Update Date | 04/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 71 ESTESS RD LOT 1
-----------------------------------------------------
City | TYLERTOWN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39667-6017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-981-3340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 ESTESS RD LOT 1
-----------------------------------------------------
City | TYLERTOWN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39667-6017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-981-3340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number | 1482075
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------