Individual
MICAH POOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
219 PHILADELPHIA RD, PINEVILLE, LA 71360-9136
(318) 452-2988
Mailing address
219 PHILADELPHIA RD, PINEVILLE, LA 71360-9136
(318) 452-2988
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
328815
LA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
02/20/2021
Last updated
09/25/2021
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