Provider Demographics
NPI:1316217953
Name:BOCK, MELISSA CORNETT (APN; PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:CORNETT
Last Name:BOCK
Suffix:
Gender:F
Credentials:APN; PMHNP-BC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:D
Other - Last Name:CORNETT-KEARNELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:2577 NE COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7638
Mailing Address - Country:US
Mailing Address - Phone:541-322-7521
Mailing Address - Fax:541-322-7565
Practice Address - Street 1:2577 NE COURTNEY DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7638
Practice Address - Country:US
Practice Address - Phone:541-322-7521
Practice Address - Fax:541-322-7565
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRN # 1095982163WP0808X
OR201601087363LP0808X
OR201600791163W00000X
KYAPRN# 3007370363LP0808X
TNAPN18054363LP0808X
TNRN157517163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse