Healthcare Provider Details

I. General information

NPI: 1356965370
Provider Name (Legal Business Name): ROBIN R POLLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN R POLLOCK BA

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S HARRILL AVE
WAGONER OK
74467-5317
US

IV. Provider business mailing address

109 S HARRILL AVE
WAGONER OK
74467-5317
US

V. Phone/Fax

Practice location:
  • Phone: 918-485-0242
  • Fax: 918-485-0204
Mailing address:
  • Phone: 918-485-0242
  • Fax: 918-485-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: