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NPI Code Detail

MEDICARE: GARY L. POOLE

MEDICARE: GARY L. POOLE
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
1363L00000XNurse PractitionerAO1177AR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00115264OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
35J597OTHERARBCBS
41316914724OTHERPROVIDER INDIVIDUAL NPI#
55C958OTHERARBLUE CROSS AND BLUE SHIEL

General Provider Information

NPI Number : 1962521617
Entity Type Code : Organization
Provider Name (Legal Business Name) : GARY L. POOLE
Provider Business Mailing Address
First Line : 218 CHURCH ST
Second Line :
City : STAMPS
State : AR
Zip : 71860-2816
Country : US
Telephone Number : 870-533-8808
Fax Number : 870-533-8838
Provider Business Practice Location Address
First Line : 218 CHURCH ST
Second Line :
City : STAMPS
State : AR
Zip : 71860-2816
Country : US
Telephone Number : 870-533-8808
Fax Number : 870-533-8838
Authorized Official
Title or Position : OWNER
Name : MR. GARY L. POOLE
Credential : APN
Telephone Number : 870-533-8808
Provider Enumeration Date : 03/27/2007
Last Update Date : 06/24/2008

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