Provider Demographics
NPI:1144838160
Name:POOL, KIMBERLY MAYO (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MAYO
Last Name:POOL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 WELL SPRING RD
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:LA
Mailing Address - Zip Code:71225-8540
Mailing Address - Country:US
Mailing Address - Phone:318-235-8571
Mailing Address - Fax:
Practice Address - Street 1:1232 SHEPPARD ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3460
Practice Address - Country:US
Practice Address - Phone:318-377-7116
Practice Address - Fax:318-377-9979
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA213733208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty