Provider Demographics
NPI:1518537638
Name:POLLARD, DUSTIN RYAN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:RYAN
Last Name:POLLARD
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 S COLTRANE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6730
Mailing Address - Country:US
Mailing Address - Phone:405-757-7818
Mailing Address - Fax:
Practice Address - Street 1:257 S COLTRANE RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6730
Practice Address - Country:US
Practice Address - Phone:405-757-7818
Practice Address - Fax:405-703-0645
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK203953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily