Healthcare Provider Details

I. General information

NPI: 1548678188
Provider Name (Legal Business Name): JOANNA POOLE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 BERT KOUNS INDUSTRIAL LOOP STE A
SHREVEPORT LA
71118-3351
US

IV. Provider business mailing address

2120 BERT KOUNS INDUSTRIAL LOOP STE A
SHREVEPORT LA
71118-3351
US

V. Phone/Fax

Practice location:
  • Phone: 318-688-3350
  • Fax:
Mailing address:
  • Phone: 318-688-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP126094
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP08760
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: