Provider Demographics
NPI:1558755926
Name:POGUE, JOHNNIE (LPN)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:
Last Name:POGUE
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:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36461-0964
Mailing Address - Country:US
Mailing Address - Phone:251-575-4837
Mailing Address - Fax:251-575-9459
Practice Address - Street 1:530 HORNADY DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-8658
Practice Address - Country:US
Practice Address - Phone:251-575-4837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-053273164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse