Healthcare Provider Details

I. General information

NPI: 1144862855
Provider Name (Legal Business Name): REBECCA ANNE POLLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5541 HIGHWAY 1
MARKSVILLE LA
71351-2650
US

IV. Provider business mailing address

5541 HIGHWAY 1
MARKSVILLE LA
71351-2650
US

V. Phone/Fax

Practice location:
  • Phone: 318-240-7240
  • Fax: 318-240-7118
Mailing address:
  • Phone: 318-240-7240
  • Fax: 318-240-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number222015
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN148519
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: