Healthcare Provider Details

I. General information

NPI: 1497673883
Provider Name (Legal Business Name): BRYAN KEVIN POOLE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5777 E MAYO BLVD
PHOENIX AZ
85054-4502
US

IV. Provider business mailing address

4207 N 27TH ST APT 5
PHOENIX AZ
85016-5763
US

V. Phone/Fax

Practice location:
  • Phone: 480-574-6304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN188290
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN188290
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: