Provider Demographics
NPI:1245983436
Name:POOLE, VALERIE NICOLE (MS, LAT, ATC)
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:NICOLE
Last Name:POOLE
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 REGENCY DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2059
Mailing Address - Country:US
Mailing Address - Phone:540-470-1934
Mailing Address - Fax:
Practice Address - Street 1:2BCT, 82ND AIRBORNE DIVISION
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28307
Practice Address - Country:US
Practice Address - Phone:910-240-3458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0017642255A2300X
IA1154992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer