Provider Demographics
NPI:1780116541
Name:WHITAKER-POOLE, JESSICA DOMINIQUE (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DOMINIQUE
Last Name:WHITAKER-POOLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 6015
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229
Mailing Address - Country:US
Mailing Address - Phone:513-636-0800
Mailing Address - Fax:513-803-0823
Practice Address - Street 1:5899 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1651
Practice Address - Country:US
Practice Address - Phone:513-803-8200
Practice Address - Fax:513-803-8173
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.1465772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program