Healthcare Provider Details

I. General information

NPI: 1467992925
Provider Name (Legal Business Name): JESSICA POOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5135 CAMINO AL NORTE STE 279
NORTH LAS VEGAS NV
89031-2420
US

IV. Provider business mailing address

5135 CAMINO AL NORTE STE 279
NORTH LAS VEGAS NV
89031-2420
US

V. Phone/Fax

Practice location:
  • Phone: 702-278-3919
  • Fax:
Mailing address:
  • Phone: 702-278-3919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number20171130774
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: