MEDICARE: POOLE FAMILY WELLNESS CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1134926371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POOLE FAMILY WELLNESS CLINIC

Provider Business Mailing Address
First Line	:	211 S MAIN ST
Second Line	:
City	:	ABBEVILLE
State	:	LA
Zip	:	70510-5907
Country	:	US
Telephone Number	:	337-516-1770
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 S MAIN ST
Second Line	:
City	:	ABBEVILLE
State	:	LA
Zip	:	70510-5907
Country	:	US
Telephone Number	:	337-516-1770
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIELLE FONTENOT POOLE
Credential	:	NP
Telephone Number	:	337-516-1770

Provider Enumeration Date	:	02/26/2025
Last Update Date	:	02/13/2026

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