Provider Demographics
NPI:1124140264
Name:POOVEY, CORI LYN (WHCNP)
Entity type:Individual
Prefix:
First Name:CORI
Middle Name:LYN
Last Name:POOVEY
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:CORI
Other - Middle Name:LYN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHCNP
Mailing Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4278
Mailing Address - Country:US
Mailing Address - Phone:972-231-9144
Mailing Address - Fax:972-231-9174
Practice Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY STE 400
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4278
Practice Address - Country:US
Practice Address - Phone:972-231-9144
Practice Address - Fax:972-231-9174
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX611168363LX0001X
TXAP112329363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D2009Medicare ID - Type Unspecified