Healthcare Provider Details

I. General information

NPI: 1487859351
Provider Name (Legal Business Name): SUSAN ASHLEY POORE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N KING ST STE B
HENDERSONVILLE NC
28792-4349
US

IV. Provider business mailing address

PO BOX 360
SYLVA NC
28779-0360
US

V. Phone/Fax

Practice location:
  • Phone: 828-693-9199
  • Fax: 855-308-2340
Mailing address:
  • Phone: 888-339-6065
  • Fax: 828-538-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12465
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: