Provider Demographics
NPI:1447803267
Name:MOCK, AMY KATHLEEN (RN, CNP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:KATHLEEN
Last Name:MOCK
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:575 WESTAR XING STE 102
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7815
Mailing Address - Country:US
Mailing Address - Phone:740-334-7656
Mailing Address - Fax:
Practice Address - Street 1:575 WESTAR XING STE 102
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7815
Practice Address - Country:US
Practice Address - Phone:614-839-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-21
Last Update Date:2019-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025167363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health