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General NPI Number Information
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NPI Number | 1366065104
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Entity Type | Individual
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Provider Name | STACEY ANN POOLE DNP, RN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/27/2020
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 521 RISEN STAR DR
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City | CRESTVIEW
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State | FL
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Zip | 32539-6071
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Country | US
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Telephone | 480-608-5157
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Fax |
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Provider Business Mailing Address
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Address Line | 521 RISEN STAR DR
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City | CRESTVIEW
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State | FL
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Zip | 32539-6071
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Country | US
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Telephone | 480-808-9505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 245674
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP145602
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11012113
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9559718
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License Number State | FL
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