Provider Demographics
NPI:1992700272
Name:POE, MAUREEN ADRIAN (APRN)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ADRIAN
Last Name:POE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6464 CORBINA RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-7674
Mailing Address - Country:US
Mailing Address - Phone:337-526-6774
Mailing Address - Fax:337-375-0021
Practice Address - Street 1:921 1ST AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-3424
Practice Address - Country:US
Practice Address - Phone:337-526-6774
Practice Address - Fax:337-375-0021
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP01864207QA0505X, 207QG0300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1113115Medicaid
LA1113115Medicaid
LAP43056Medicare UPIN