Provider Demographics
NPI:1568427169
Name:POOL, ASHLEY BAILEY (CRNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BAILEY
Last Name:POOL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:BAILEY
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7715 US HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-8979
Mailing Address - Country:US
Mailing Address - Phone:256-729-9477
Mailing Address - Fax:256-216-9729
Practice Address - Street 1:7715 US HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-8979
Practice Address - Country:US
Practice Address - Phone:256-729-9477
Practice Address - Fax:256-216-9729
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-087387363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051557220WISMedicare ID - Type Unspecified