Provider Demographics
NPI:1164289401
Name:BROCK, SARAH KATHERINE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHERINE
Last Name:BROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 SHADY CIR
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-2029
Mailing Address - Country:US
Mailing Address - Phone:423-208-7831
Mailing Address - Fax:
Practice Address - Street 1:908 SHADY CIR
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-2029
Practice Address - Country:US
Practice Address - Phone:423-208-7831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant