Provider Demographics
NPI:1619256583
Name:POOLE, MELISSA ANN (CNM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:POOLE
Suffix:
Gender:F
Credentials:CNM
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 58
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28802-0058
Mailing Address - Country:US
Mailing Address - Phone:770-845-0295
Mailing Address - Fax:
Practice Address - Street 1:390 S FRENCH BROAD AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4364
Practice Address - Country:US
Practice Address - Phone:828-378-0075
Practice Address - Fax:828-378-0083
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC203320163W00000X
NC498367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC517241Medicaid
Q42669BMedicare UPIN