Provider Demographics
NPI:1508907171
Name:BROCK, KAREN DALE (CPM TN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:DALE
Last Name:BROCK
Suffix:
Gender:F
Credentials:CPM TN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WILLINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-3183
Mailing Address - Country:US
Mailing Address - Phone:256-734-4593
Mailing Address - Fax:
Practice Address - Street 1:25112 UNION HILL RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:TN
Practice Address - Zip Code:38449-3168
Practice Address - Country:US
Practice Address - Phone:931-427-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCPM0000000022176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife