Provider Demographics
NPI:1831932433
Name:POOLER, JONATHAN W (APRN-CNP, PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:W
Last Name:POOLER
Suffix:
Gender:M
Credentials:APRN-CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 1/2 N WILSON ST
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301
Mailing Address - Country:US
Mailing Address - Phone:539-937-1715
Mailing Address - Fax:539-937-1735
Practice Address - Street 1:411 1/2 N WILSON ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301
Practice Address - Country:US
Practice Address - Phone:539-937-1715
Practice Address - Fax:539-937-1735
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK218365363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health