Provider Demographics
NPI:1033123781
Name:BROCK, KAREN (CNM WHNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:CNM WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 MEDICAL CENTER BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2845
Mailing Address - Country:US
Mailing Address - Phone:936-523-5790
Mailing Address - Fax:936-760-4612
Practice Address - Street 1:508 MEDICAL CENTER BLVD STE 320
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2845
Practice Address - Country:US
Practice Address - Phone:936-523-5790
Practice Address - Fax:936-760-4612
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX516186367A00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB113655Medicare PIN