MEDICARE: MS. AMY KATHLEEN MOCK RN, CNP

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	363LW0102X	Women's Health Nurse Practitioner	APRN.CNP.025167	OH

General Provider Information

NPI Number	:	1447803267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY KATHLEEN MOCK RN, CNP

Provider Business Mailing Address
First Line	:	575 WESTAR XING STE 102
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-7815
Country	:	US
Telephone Number	:	740-334-7656
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 WESTAR XING STE 102
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-7815
Country	:	US
Telephone Number	:	614-839-5555
Fax Number	:

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

Provider Enumeration Date	:	07/21/2019
Last Update Date	:	07/21/2019

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