Healthcare Provider Details

I. General information

NPI: 1942679196
Provider Name (Legal Business Name): KEVIN GREGORY POLLOCK N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR SUITE 1500
ST GEORGE UT
84790-2123
US

IV. Provider business mailing address

1380 E MEDICAL CENTER DR SUITE 1500
ST GEORGE UT
84790-2123
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-2500
  • Fax: 435-251-2525
Mailing address:
  • Phone: 435-251-2500
  • Fax: 435-251-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6086422-8900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: