Healthcare Provider Details

I. General information

NPI: 1275641987
Provider Name (Legal Business Name): PENELOPE POLLOCK APN/CNS, RNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

5 CHELSEA RD
LITTLE ROCK AR
72212-3723
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-3085
  • Fax: 501-257-3025
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR21899
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberP00437
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberS01083
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: