Provider Demographics
NPI:1548462161
Name:POOLE, RICHARD WILLIAM (PA-C)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:POOLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:118 GAYMONT CIR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8320
Mailing Address - Country:US
Mailing Address - Phone:704-873-1855
Mailing Address - Fax:
Practice Address - Street 1:2280 US HIGHWAY 70 SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-5164
Practice Address - Country:US
Practice Address - Phone:828-270-7331
Practice Address - Fax:828-322-3280
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10300363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical