Healthcare Provider Details

I. General information

NPI: 1265159693
Provider Name (Legal Business Name): KELLY POLLARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MICHIGAN AVE
JOINT BASE CHARLESTON SC
29404-2020
US

IV. Provider business mailing address

1000 MICHIGAN AVE
JOINT BASE CHARLESTON SC
29404-2020
US

V. Phone/Fax

Practice location:
  • Phone: 843-767-5914
  • Fax:
Mailing address:
  • Phone: 843-767-5914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number88910
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: