Provider Demographics
NPI:1457712549
Name:POOLE, JOSEPH (NP-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:POOLE
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 GALISTEO ST
Mailing Address - Street 2:STE D
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4781
Mailing Address - Country:US
Mailing Address - Phone:505-954-1921
Mailing Address - Fax:505-954-1922
Practice Address - Street 1:1691 GALISTEO ST STE D
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4781
Practice Address - Country:US
Practice Address - Phone:505-954-1921
Practice Address - Fax:505-983-6520
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55685363L00000X, 363LF0000X
TXAP130570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily