Provider Demographics
NPI:1336442011
Name:POGUE, DEBRA DIANNE (MSN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:DIANNE
Last Name:POGUE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10475 MONTGOMERY RD
Mailing Address - Street 2:SUITE 1J
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5201
Mailing Address - Country:US
Mailing Address - Phone:513-791-5548
Mailing Address - Fax:513-791-5549
Practice Address - Street 1:10475 MONTGOMERY RD
Practice Address - Street 2:SUITE 1J
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5201
Practice Address - Country:US
Practice Address - Phone:513-791-5548
Practice Address - Fax:513-791-5549
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207892163W00000X
OH10721363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3109648Medicaid
IN201008380AMedicaid
KY7100153790Medicaid
INM400035449Medicare PIN
KY7100153790Medicaid