Provider Demographics
NPI:1104041854
Name:POOLE, MICHELLE RARITY (RN, CNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RARITY
Last Name:POOLE
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:K
Other - Last Name:RARITY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNP
Mailing Address - Street 1:1301 BARBARA JORDAN BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-478-8116
Mailing Address - Fax:
Practice Address - Street 1:1301 BARBARA JORDAN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723
Practice Address - Country:US
Practice Address - Phone:512-478-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX634968363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics