KENNEDY POOLE (NPI# 1053928622) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1053928622 |
Entity Type | Individual |
Full Name | KENNEDY POOLE |
Credential | PA-C |
Practice Address |
1643 Carter St Ste 1 Vidalia LA 71373-3157 |
Mailing Address |
8832 Highway 129 Monterey LA 71354-4551 |
Practice Telephone | 3183368707 |
Enumeration Date | 2020-09-28 |
Last Update Date | 2020-09-28 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
324530 | LA | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
1643 CARTER ST STE 1 |
City | VIDALIA |
State | LA |
Zip Code | 71373-3157 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1710513494 | Total Urgent Care | Clinic/Center | 4014 Carter Street, Vidalia, LA 71373 | 2020-03-13 |
1609412097 | Hulin Urgent Care Services, LLC | Clinic/Center | 4319 Highway 84, Vidalia, LA 71373 | 2019-11-21 |
1720562556 | Neashion Marie Davis | Counselor | 1644 B Carter Street. Suite #2, Vidalia, LA 71373 | 2018-09-18 |
1992292403 | Angelica Francheska Woods | Counselor | 1644 B. Carter Street Suite 2, Vidalia, LA 71373 | 2018-04-19 |
1164973780 | Linda Sherbia | Counselor | 1644 B Carter St., Suite 2, Vidalia, LA 71373 | 2016-10-19 |
1518418045 | Cheryl Clark | Case Manager/Care Coordinator | 1644 B Carter Suite 2, Vidalia, LA 71373 | 2016-10-19 |
1972054500 | Sherry Cade | Counselor | 1644 B Carter Street, Suite 2, Vidalia, LA 71373 | 2016-10-19 |
1457801136 | Sarai Johnson | Counselor | 1644 B Carter Street Suite 2, Vidalia, LA 71373 | 2016-10-06 |
1053766410 | Erin Fournet Woodruff | Physical Therapist | 402 Holly Street, Vidalia, LA 71373 | 2016-05-04 |
1184084113 | Troy Nolan Thomas Jr. | Counselor | 4012 Carter St., Vidalia, LA 71373 | 2016-03-03 |
Find all providers in zip 71373 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1932253606 | John Burton Derrick | Physician Assistant | 300 Arlington Dr, Vidalia, GA 30474-0645 | 2007-01-22 |
1689163685 | Daniel Lauren Dasher | Physician Assistant | 210 Mose Coleman Dr, Vidalia, GA 30474-8677 | 2018-05-04 |
1962873711 | Leah M Waller | Physician Assistant | 1 Meadows Pkwy, Vidalia, GA 30474-8759 | 2015-10-19 |
1063759744 | Rebecca Arthur Foster | Physician Assistant | 1154 Logan Sewell Dr, Vidalia, LA 71373-3342 | 2013-01-15 |
1982698361 | Dustin J Carter | Physician Assistant | 200 Maple Dr, Vidalia, GA 30474-8907 | 2005-08-31 |
1265426639 | Robert Lee Arnold | Physician Assistant | 200 Maple Dr, Vidalia, GA 30474-8907 | 2005-08-31 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1174120307 | Olivia Hockenjos | Physician Assistant | 1000 Chinaberry Dr Ste 1200, Bossier City, LA 71111-2463 | 2020-10-01 |
1699382176 | Morgan Prejean | Physician Assistant | 11445 Coursey Blvd Ste L, Baton Rouge, LA 70816-0411 | 2020-09-28 |
1972118776 | Emma W Bollich | Physician Assistant | 6703 Ambassador Caffery Pkwy Ste 2, Broussard, LA 70518-5283 | 2020-09-09 |
1316595937 | Antonia Colombo | Physician Assistant | 2705 Fable St, Meraux, LA 70075-2372 | 2019-08-27 |
1861058752 | Christina Daigle | Physician Assistant | 1057 Paul Maillard Rd Ste 2210, Luling, LA 70070-4349 | 2019-05-15 |
1376078022 | Brian Ammon | Physician Assistant | 11831 Oakwilde Ave, Baton Rouge, LA 70810-3120 | 2017-05-01 |
1912448036 | Christy Stoltz | Physician Assistant | 120 N Pinaud St, Saint Martinville, LA 70582-4732 | 2017-03-09 |
1790228013 | Brian Keith Fontenot | Physician Assistant | 2751 Albert L Bicknell Dr Ste 5c, Shreveport, LA 71103-3943 | 2016-11-18 |
1932658002 | Taylor Christensen Mahtook | Physician Assistant | 4650 Ambassador Caffery Pkwy Ste 101, Lafayette, LA 70508-6926 | 2016-09-29 |
1558819532 | Heather Roan | Physician Assistant | 2449 Hospital Dr Ste 400, Bossier City, LA 71111-1914 | 2016-09-19 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.