Healthcare Provider Details

I. General information

NPI: 1053293795
Provider Name (Legal Business Name): MIKAYLA POLLARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 ALM ST STE 1200
RALEIGH NC
27617-8221
US

IV. Provider business mailing address

9109 SHALLCROSS WAY
RALEIGH NC
27617-8383
US

V. Phone/Fax

Practice location:
  • Phone: 919-206-4889
  • Fax:
Mailing address:
  • Phone: 714-376-0617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5022701
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: