Provider Demographics
NPI:1760168454
Name:MOCK, MARY STEELE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY STEELE
Middle Name:
Last Name:MOCK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 MERCER WAY
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1729 MERCER WAY
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TX
Practice Address - Zip Code:76227-7732
Practice Address - Country:US
Practice Address - Phone:662-897-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily