Healthcare Provider Details

I. General information

NPI: 1700758844
Provider Name (Legal Business Name): LEAH JEANNE POLLOCK MSN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEAH JACKSON

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 FRY CRK
SAGLE ID
83860-9084
US

IV. Provider business mailing address

104 FRY CRK
SAGLE ID
83860-9084
US

V. Phone/Fax

Practice location:
  • Phone: 208-217-2984
  • Fax:
Mailing address:
  • Phone: 208-217-2984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1481009
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: