Provider Demographics
NPI:1518509801
Name:POOLE, WHITNEY MICHELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MICHELLE
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 1:213 JOE FARLOW RD
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-1200
Mailing Address - Country:US
Mailing Address - Phone:336-628-2812
Mailing Address - Fax:
Practice Address - Street 1:2616 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4343
Practice Address - Country:US
Practice Address - Phone:336-628-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012403363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1912199415Medicaid