Provider Demographics
NPI:1487859351
Name:POORE, SUSAN ASHLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ASHLEY
Last Name:POORE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0360
Mailing Address - Country:US
Mailing Address - Phone:888-339-6065
Mailing Address - Fax:828-538-4441
Practice Address - Street 1:317 N KING ST STE B
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-4349
Practice Address - Country:US
Practice Address - Phone:828-693-9199
Practice Address - Fax:855-308-2340
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12465363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ00378759OtherRAILROAD MEDICARE
NC146E3OtherBCBS NC
NCNNN587AOtherMEDICARE
NC6104079Medicaid