Basic Information
| Provider Information | |||||||||
| NPI: | 1457712549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POOLE | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1691 GALISTEO ST | ||||||||
| Address2: | STE D | ||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875054781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059541921 | ||||||||
| FaxNumber: | 5059541922 | ||||||||
| Practice Location | |||||||||
| Address1: | 1691 GALISTEO ST STE D | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875054781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059541921 | ||||||||
| FaxNumber: | 5059836520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2016 | ||||||||
| LastUpdateDate: | 09/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 55685 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AP130570 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.