Provider Demographics
NPI:1154034684
Name:POORE, BROOKELYN
Entity type:Individual
Prefix:
First Name:BROOKELYN
Middle Name:
Last Name:POORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MOUNTAIN TOP DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-9272
Mailing Address - Country:US
Mailing Address - Phone:304-951-1271
Mailing Address - Fax:
Practice Address - Street 1:307 MOUNTAIN TOP DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-9272
Practice Address - Country:US
Practice Address - Phone:304-951-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant