Active NPI
Nicole Myers Brock, D.D.S.
- Dentist
- Jasper, TN
National Provider Identifier
1124317037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9195
- Practice address
- 507 Betsy Pack Dr
Jasper, TN 37347-3321 - Phone
- (423) 942-5508
- NPI assigned
- Mar 31, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9195 | TN | Primary |
Addresses
Primary practice location
507 Betsy Pack Dr
Jasper, TN 37347-3321
Mailing address
507 Betsy Pack Dr
Jasper, TN 37347-3321
Phone (423) 942-5508
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9195 | TN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sequatchie Valley Dental Associates, PC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Jasper, TN
- NPI 1205062379
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370995200000",
"number": "1124317037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "507 BETSY PACK DR",
"city": "JASPER",
"state": "TN",
"postal_code": "373473321",
"telephone_number": "423-942-5508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "507 BETSY PACK DR",
"city": "JASPER",
"state": "TN",
"postal_code": "373473321",
"telephone_number": "423-942-5508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCK",
"first_name": "NICOLE",
"middle_name": "MYERS",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-03-31",
"last_updated": "2013-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "9195",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jasper, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.