Provider Demographics
NPI:1992202295
Name:POLLOCK, MICHELLE LYNN (RD, LD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 S INTERSTATE 35 E STE 111
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6868
Mailing Address - Country:US
Mailing Address - Phone:940-800-2565
Mailing Address - Fax:833-269-3376
Practice Address - Street 1:3537 S INTERSTATE 35 E STE 111
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210
Practice Address - Country:US
Practice Address - Phone:940-800-2565
Practice Address - Fax:833-269-3376
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84411133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered