Provider Demographics
NPI:1699934455
Name:POOLE, KIM ALISON (RN, BSN)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:ALISON
Last Name:POOLE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 PUBLIC LANDING RD
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-2453
Mailing Address - Country:US
Mailing Address - Phone:410-957-2005
Mailing Address - Fax:410-957-2417
Practice Address - Street 1:400 WALNUT ST STE A
Practice Address - Street 2:
Practice Address - City:POCOMOKE CITY
Practice Address - State:MD
Practice Address - Zip Code:21851-1501
Practice Address - Country:US
Practice Address - Phone:410-957-2005
Practice Address - Fax:410-957-2417
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR209277163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health