Doctor Name: | HEIDI MERISSA POORE |
NPI Number: | 1215281969 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PMHNP |
License Number: | 17149 |
Business Practice Address: | 1104 Foxwood Dr Sevierville, TN - 378626000 |
Business Phone Number: | 8659709800 |
Business Fax Number: | 8653747129 |
Mailing Address: | 1451 Dowell Springs Blvd, KNOXVILLE |
State: | TN |
Postal Code: | 379092441 |
Phone Number: | 8653747123 |
Fax Number: | 8653747129 |
NPI Enumeration Date: | 11/02/2012 |
NPI Last Update Date: | 09/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | 17149 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |