Provider Demographics
NPI:1114636214
Name:POE, AGNES CHRISTINE (LPN)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:CHRISTINE
Last Name:POE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TELETECH DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-2790
Mailing Address - Country:US
Mailing Address - Phone:304-221-4506
Mailing Address - Fax:304-221-3301
Practice Address - Street 1:100 TELETECH DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041
Practice Address - Country:US
Practice Address - Phone:304-221-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26567164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse