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General NPI Number Information
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NPI Number | 1104263268
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Entity Type | Organization
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Legal Business Name | KCR HEALTHCARE, PLLC
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 1805 MONUMENT AVE SUITE 410
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City | RICHMOND
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State | VA
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Zip | 23220-7005
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Country | US
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Telephone | 804-921-1164
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Fax |
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Provider Business Mailing Address
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Address Line | 1805 MONUMENT AVE SUITE 410
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City | RICHMOND
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State | VA
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Zip | 23220-7005
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Country | US
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Telephone | 804-921-1164
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CAROL J. POLLOCK
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Credential | RN, FNP
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Telephone | 804-921-1164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0024146888
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License Number State | VA
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