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NPI Code Detail

MEDICARE: KELLY MELISSA BOCK NP-C

MEDICARE: KELLY MELISSA BOCK NP-C
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
1363LF0000XFamily Nurse Practitioner670013TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1670013OTHERTXNURSING LICENSE
2F0511108OTHERTXNURSE PRACTITIONER CERTIFICATION

General Provider Information

NPI Number : 1205121548
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MELISSA BOCK NP-C
Provider Business Mailing Address
First Line : 615 W ROUND BUNCH RD
Second Line :
City : BRIDGE CITY
State : TX
Zip : 77611-2434
Country : US
Telephone Number : 409-735-7305
Fax Number : 409-735-3371
Provider Business Practice Location Address
First Line : 615 W ROUND BUNCH RD
Second Line :
City : BRIDGE CITY
State : TX
Zip : 77611-2434
Country : US
Telephone Number : 409-735-7305
Fax Number : 409-735-3371
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2011
Last Update Date : 11/15/2012

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