MEDICARE: MERCY OROCK 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	APRN.CNP.0039460	OH
2	163W00000X	Registered Nurse	RN500278	OH

General Provider Information

NPI Number	:	1518666320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCY OROCK PMHNP

Provider Business Mailing Address
First Line	:	707 S EDWIN C MOSES BLVD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-3462
Country	:	US
Telephone Number	:	937-234-2611
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 S EDWIN C MOSES BLVD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-3462
Country	:	US
Telephone Number	:	937-234-2611
Fax Number	:

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

Provider Enumeration Date	:	03/01/2023
Last Update Date	:	06/09/2026

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