MEDICARE: MS. EVELYN W POE

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	172V00000X	Community Health Worker		NC
2	172A00000X	Driver	5705984	NC

General Provider Information

NPI Number	:	1740079409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EVELYN W POE

Provider Business Mailing Address
First Line	:	3715 BARDOT DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-3120
Country	:	US
Telephone Number	:	704-963-1657
Fax Number	:

Provider Business Practice Location Address
First Line	:	3715 BARDOT DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-3120
Country	:	US
Telephone Number	:	704-963-1657
Fax Number	:	704-963-1657

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	02/02/2026

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