Healthcare Provider Details

I. General information

NPI: 1164112892
Provider Name (Legal Business Name): CARIN POORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7976 DAIRY LN
ATHENS OH
45701-9391
US

IV. Provider business mailing address

PO BOX 188
CHILLICOTHEE OH
45601-0188
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-5164
  • Fax: 740-594-6829
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-773-4426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.518519
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: