MEDICARE: MRS. CRYSTAL DIANE MOCK PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	41230	TN

General Provider Information

NPI Number	:	1134073588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRYSTAL DIANE MOCK PMHNP

Provider Business Mailing Address
First Line	:	2410 PATTERSON ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1551
Country	:	US
Telephone Number	:	727-560-7867
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 PATTERSON ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1551
Country	:	US
Telephone Number	:	615-457-8585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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