Provider Demographics
NPI:1811412083
Name:POE, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:POE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5718 US HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35146-3249
Mailing Address - Country:US
Mailing Address - Phone:205-467-3591
Mailing Address - Fax:
Practice Address - Street 1:5718 US HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146-3249
Practice Address - Country:US
Practice Address - Phone:205-467-3591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-32456CRNP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-32459CRNPOtherSTATE LICENSE