Healthcare Provider Details

I. General information

NPI: 1376557587
Provider Name (Legal Business Name): KEVIN POLLOCK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/05/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LIGO RD
MERCER PA
16137-4936
US

IV. Provider business mailing address

310 LIGO RD
MERCER PA
16137-4936
US

V. Phone/Fax

Practice location:
  • Phone: 724-475-4929
  • Fax:
Mailing address:
  • Phone: 724-475-4929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-318882-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: