Provider Demographics
NPI:1366756975
Name:POLLOCK, KRISTEN N (DO)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2461
Mailing Address - Country:US
Mailing Address - Phone:419-238-6251
Mailing Address - Fax:419-232-2245
Practice Address - Street 1:1178 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2461
Practice Address - Country:US
Practice Address - Phone:419-238-6251
Practice Address - Fax:419-232-2245
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.003579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0078520Medicaid
OH0078520Medicaid