Provider Demographics
NPI:1003627753
Name:BROCK, TESSA L (RN)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:L
Last Name:BROCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:L
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5315 N PEBBLECREEK CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2284
Mailing Address - Country:US
Mailing Address - Phone:316-882-2101
Mailing Address - Fax:
Practice Address - Street 1:5315 N PEBBLECREEK CT
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67226-2284
Practice Address - Country:US
Practice Address - Phone:316-882-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS125685163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse