Provider Demographics
NPI:1699784520
Name:POOL, SHELLEY HARDIE (FNP-C)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:HARDIE
Last Name:POOL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MYRICK RD NW
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-8276
Mailing Address - Country:US
Mailing Address - Phone:478-968-0313
Mailing Address - Fax:
Practice Address - Street 1:100 MYRICK RD NW
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-8276
Practice Address - Country:US
Practice Address - Phone:478-968-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN118322OtherLICENSE