Healthcare Provider Details

I. General information

NPI: 1013404748
Provider Name (Legal Business Name): ABBY JO POLLOCK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ABBY JO WILLIAMS

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 NALL AVE STE 200
OVERLAND PARK KS
66211-1358
US

IV. Provider business mailing address

10701 NALL AVE STE 200
OVERLAND PARK KS
66211-1358
US

V. Phone/Fax

Practice location:
  • Phone: 913-381-5225
  • Fax: 913-901-0186
Mailing address:
  • Phone: 913-381-5225
  • Fax: 913-901-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2018012575
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: