Basic Information
| Provider Information | |||||||||
| NPI: | 1215477922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POOLE | ||||||||
| FirstName: | SHAREKA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | POOLE | ||||||||
| OtherFirstName: | SHAREKA | ||||||||
| OtherMiddleName: | D. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | R. N. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 200 N THOMAS DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711076503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184248345 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 N THOMAS DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711076503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184248345 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2017 | ||||||||
| LastUpdateDate: | 02/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 135433 | LA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.