| Doctor Name: | AMANDA DEE BROCK |
| NPI Number: | 1013165786 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 5621P |
| Business Practice Address: | 177 Washington Dr Somerset, KY - 425012938 |
| Business Phone Number: | 6066782880 |
| Business Fax Number: | 6066782886 |
| Mailing Address: | 177 Washington Dr, SOMERSET |
| State: | KY |
| Postal Code: | 425012938 |
| Phone Number: | 6066782880 |
| Fax Number: | 6066782886 |
| NPI Enumeration Date: | 09/05/2008 |
| NPI Last Update Date: | 07/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WG0000X |
| License Number: | 5621P |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | General Practice |
| Taxonomy Definition: | |