Organization
COUNTRYSIDE PSYCHIATRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN W POOLER APRN-CNP, PMHNP-BC (OWNER)
(539) 937-1715
Entity
Organization
Contact information
Practice address
411 1/2 N WILSON ST, VINITA, OK 74301
(539) 937-1715
(539) 937-1735
Mailing address
411 1/2 N WILSON ST, VINITA, OK 74301
(539) 937-1715
(539) 937-1735
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/15/2025
Last updated
06/13/2025
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