MRS. JESSICA NICOLE BROCK (NPI# 1053540450) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053540450 |
| Entity Type | Individual |
| Full Name | MRS. JESSICA NICOLE BROCK |
| Credential | CRNP |
| Practice Address |
5955 Airport Blvd Mobile AL 36608 |
| Mailing Address |
Po Box 7987 Mobile AL 36670-0987 |
| Practice Telephone | 2516330573 |
| Practice Fax Number | 2516337367 |
| Mailing Telephone | 2516330573 |
| Mailing Fax Number | 2516337367 |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2019-06-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 1-106242 | AL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
1-106242 | AL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 222576 | 05 | |
| AL | AETNA | 9582378 | 01 |
| AL | 134189 | 05 | |
| AL | VIVA HEALTH | Z12803 | 01 |
| MS | MS MEDICAID | 02482035 | 01 |
| AL | MEDICARE | 102I502393 | 01 |
| AL | UHC | 3092229 | 01 |
| AL | BCBS | 512-05479 | 01 |
| AL | 214094 | 05 | |
| AL | BCBS | 512-05477 | 01 |
| AL | BCBS | 510-49658 | 01 |
| AL | RR MEDICARE | P00927530 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 100 Memorial Hospital Dr Ste 1a, Mobile, AL 366081128 | 2513436848 | 2513435708 |
| 2001 Spring Hill Ave, Mobile, AL 366073326 | 2514333344 | 2514334052 |
| 3 Mobile Infirmary Cir Ste 410, Mobile, AL 366073512 | 2514333344 | 2514334052 |
| 6701 Airport Blvd, Suite B-135, Mobile, AL 366086705 | 2516330573 | 2516334853 |
| 8725 County Road 64, Daphne, AL 365266061 | 2516251370 | 2516251380 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356909360 | Jessica Beth Brock | Early Intervention Provider Agency | 42 Gwendolyn Pl, East Islip, NY 11730-3220 | 2019-06-04 |
| 1902125024 | Jessica C Brock | Physician Assistant | Endocrinology Clinic, 740 S. Limestone, Lexington, KY 40536-0284 | 2010-05-28 |
| 1962636233 | Jessica M Brock | Radiologic Technologist | 169 Highland Dr, Mandeville, LA 70471 | 2009-05-14 |
| 1376157578 | Jessica Shae Brock | Technician | 87 Swierkos Dr, Moundsville, WV 26041-4209 | 2020-09-04 |
| 1851846802 | Jessica Suzanne Brock | Specialist/Technologist | 180 Hansen Ct, Wood Dale, IL 60191-1121 | 2016-08-19 |
| 1891191102 | Jessica Brock | Physical Therapist | 125 Dillmont Dr, Columbus, OH 43235-4658 | 2014-11-13 |
| 1295148914 | Jessica Marie Brock | Nurse Practitioner | 1010 Main St S, Mc Kee, KY 40447-7089 | 2014-06-10 |
| 1740582915 | Jessica Brock | Licensed Practical Nurse | 1680 Walden Ave, Cheektowaga, NY 14225-4914 | 2010-11-22 |
| 1699925537 | Jessica Gray Brock | Physician Assistant | 4207 Lake Boone Trl Ste 220, Raleigh, NC 27607-6685 | 2008-09-29 |
| Street Address |
5955 AIRPORT BLVD |
| City | MOBILE |
| State | AL |
| Zip Code | 36608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801872353 | Allan F Seibert Iv | Internal Medicine | 5955 Airport Blvd, Mobile, AL 36608 | 2005-12-16 |
| 1962907618 | Staci Ann Robinson | Nurse Practitioner | 5955 Airport Blvd, Mobile, AL 36608 | 2018-03-26 |
| 1083165146 | Kimberly Ann Devilbiss | Clinical Nurse Specialist | 5955 Airport Blvd, Mobile, AL 36608 | 2016-10-24 |
| 1043617855 | Brandi Lee Kohn | Nurse Practitioner | 5955 Airport Blvd, Mobile, AL 36608 | 2014-11-21 |
| 1346661410 | Ashley Weaver Wiggins | Nurse Practitioner | 5955 Airport Blvd, Mobile, AL 36608 | 2013-12-17 |
| 1154769545 | Lukasz Myc | Internal Medicine | 5955 Airport Blvd, Mobile, AL 36608-3135 | 2013-06-07 |
| 1023321411 | William Bradley Pitts | Internal Medicine | 5955 Airport Blvd, Mobile, AL 36608 | 2010-07-14 |
| 1801054754 | Michael Gilchrist Gates | Allergy & Immunology | 5955 Airport Blvd, Mobile, AL 36608 | 2008-05-28 |
| 1174743223 | Donald Lawrence Bedsole | Internal Medicine | 5955 Airport Blvd, Mobile, AL 36608 | 2007-04-30 |
| 1790718658 | Casey Wayne Melton | Internal Medicine | 5955 Airport Blvd, Mobile, AL 36608 | 2006-07-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475524 | Grantham Dental, Inc. | Dentist | 3620 Springhill Memorial Drive South, Mobile, AL 36608 | 2020-10-21 |
| 1114540879 | Dearrius Hines | Home Health Aide | 1370 Lucerne Dr, Mobile, AL 36608 | 2020-05-28 |
| 1558980409 | Rachel Stevens | Registered Nurse | 8507 Tanner Williams Rd, Mobile, AL 36608 | 2020-04-10 |
| 1073170700 | Usa Health Physician Billing Services LLC | Otolaryngology | 5721 Usa Drive North, Hahn 1119, Mobile, AL 36608 | 2019-05-29 |
| 1952885600 | Franklin Primary Health Center Inc. | Dentist | 990 Cody Rd North, Mobile, AL 36608 | 2018-09-19 |
| 1114410040 | Zackary Elkins | Optometrist | 105 W I65 Service Rd N, Mobile, AL 36608 | 2018-06-14 |
| 1023562865 | Covenant Hospice, Inc. | Internal Medicine | 6801 Airport Blvd., Main Tower, 11th Floor North, Mobile, AL 36608 | 2016-08-10 |
| 1730575416 | Rayven Likely | Student in an Organized Health Care Education/Training Program | 1014 Centerwood Dr, Mobile, AL 36608 | 2015-04-09 |
| 1598040461 | Robert S Harlin | Specialist | 75 Clarise Circle, Mobile, AL 36608 | 2011-10-11 |
| 1972884948 | Heidi Michelle Mcdermott | Physical Therapist | 5721 Usa Drive N, Hahn 2050, Mobile, AL 36608 | 2011-09-06 |
| Find all providers in zip 36608 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912519091 | Latresa Chaval Davis | Nurse Practitioner | 3737 Government Blvd Ste 408, Mobile, AL 36693-4362 | 2020-08-19 |
| 1124659487 | Shanita Peoples | Nurse Practitioner | 23 Midtown Park W Ste B-1, Mobile, AL 36606-4139 | 2020-01-27 |
| 1528327517 | Shera Annette Butt | Nurse Practitioner | 2060 Autumn Leaf Dr W, Mobile, AL 36695-8494 | 2012-05-10 |
| 1780975680 | Ashley Monique Flanagan | Nurse Practitioner | 11 N Water St Fl 10, Mobile, AL 36602-5010 | 2011-04-26 |
| 1487672465 | Tammy Lynn Pugh | Nurse Practitioner | 3 Mobile Infirmary Cir Ste 305, Building B, Suite 118, Mobile, AL 36607-3515 | 2006-07-17 |
| 1821642372 | Kathryn S Coletta | Nurse Practitioner | 100 Memorial Hospital Dr Ste 2a, Mobile, AL 36608-1199 | 2019-08-01 |
| 1083267967 | Mary Pearce Benfield | Nurse Practitioner | 1700 Center St, Mobile, AL 36604-3301 | 2019-07-19 |
| 1093272874 | Lawanda S Fantroy | Nurse Practitioner | 1700 Spring Hill Ave Ste 100, Mobile, AL 36604-1416 | 2019-02-27 |
| 1447724935 | Jennifer Hansmann Umbarger | Nurse Practitioner | 1700 Spring Hill Ave, Mobile, AL 36604-1407 | 2019-01-17 |
| 1750863726 | Amy Rebecca Odom | Nurse Practitioner | 100 Memorial Hospital Dr Ste 1a, Mobile, AL 36608-1128 | 2018-09-05 |
| Find all providers in MOBILE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.