Provider Demographics
NPI:1013900703
Name:POE, DORI A (RN,FNP)
Entity Type:Individual
Prefix:
First Name:DORI
Middle Name:A
Last Name:POE
Suffix:
Gender:F
Credentials:RN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N HIGHLAND AVE, SUITE 415
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092
Mailing Address - Country:US
Mailing Address - Phone:903-868-3717
Mailing Address - Fax:903-868-0133
Practice Address - Street 1:300 N HIGHLAND AVE, SUITE 415
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-868-3717
Practice Address - Fax:903-868-0133
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168773001Medicaid
TXTXB142372Medicare PIN
TX168773001Medicaid
TXTXB142371Medicare PIN
TXTXB142373Medicare PIN
TXQ23934Medicare UPIN