Provider Demographics
NPI:1457076101
Name:IPOCK, BRIAN (PMHNP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:IPOCK
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 QUAIL HOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5967
Mailing Address - Country:US
Mailing Address - Phone:615-817-3130
Mailing Address - Fax:
Practice Address - Street 1:2010 QUAIL HOLLOW CIR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5967
Practice Address - Country:US
Practice Address - Phone:615-807-4020
Practice Address - Fax:615-771-6337
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34199363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health