Provider Demographics
NPI:1285285056
Name:POOLE, CHERISSE A
Entity type:Individual
Prefix:
First Name:CHERISSE
Middle Name:A
Last Name:POOLE
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 1:944 EDWARDS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-1411
Mailing Address - Country:US
Mailing Address - Phone:120-583-4695
Mailing Address - Fax:
Practice Address - Street 1:944 EDWARDS LAKE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-1411
Practice Address - Country:US
Practice Address - Phone:120-583-4695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider