MEDICARE: JESSICA DOMINIQUE WHITAKER-POOLE MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2084P0800X	Psychiatry Physician	35.146577	OH

General Provider Information

NPI Number	:	1780116541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DOMINIQUE WHITAKER-POOLE MD

Provider Business Mailing Address
First Line	:	3333 BURNET AVE
Second Line	:	ML 6015
City	:	CINCINNATI
State	:	OH
Zip	:	45229
Country	:	US
Telephone Number	:	513-636-0800
Fax Number	:	513-803-0823

Provider Business Practice Location Address
First Line	:	5899 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-1651
Country	:	US
Telephone Number	:	513-803-8200
Fax Number	:	513-803-8173

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

Provider Enumeration Date	:	03/31/2017
Last Update Date	:	01/13/2023

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