Provider Demographics
NPI:1164027280
Name:POOLER, JENNIFER ASHLEY
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ASHLEY
Last Name:POOLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 W LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1139
Mailing Address - Country:US
Mailing Address - Phone:859-904-9193
Mailing Address - Fax:
Practice Address - Street 1:1127 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1139
Practice Address - Country:US
Practice Address - Phone:859-904-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant