Provider Demographics
NPI:1255827218
Name:POOLE, JENAE VENTRESS (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENAE
Middle Name:VENTRESS
Last Name:POOLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16414 CONFEDERATE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-3629
Mailing Address - Country:US
Mailing Address - Phone:225-456-7380
Mailing Address - Fax:
Practice Address - Street 1:16414 CONFEDERATE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-3629
Practice Address - Country:US
Practice Address - Phone:225-456-7380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09995363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily