Provider Demographics
NPI:1295524700
Name:BROCK, SAVANNAH HOPE (APRN, CNP, RN)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:HOPE
Last Name:BROCK
Suffix:
Gender:F
Credentials:APRN, CNP, RN
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:HOPE
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:844-853-8937
Mailing Address - Fax:660-885-3690
Practice Address - Street 1:155 PARK DR
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-7860
Practice Address - Country:US
Practice Address - Phone:844-853-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH517822163W00000X
MO2025035027363LP0808X
MARN2379664163W00000X
OR10026807163W00000X
MO517822163W00000X
CA95229440163W00000X
IL041538582163W00000X
MN2525512163W00000X
NY889270163W00000X
MI4704398702163W00000X
MO2023019183163W00000X
DCRN200005895163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse