| Kendra Poole Inc | |
|
334 Backbone Rd E Princeton IL 61356-9685 | |
| (815) 303-4668 | |
| (949) 862-8061 |
| Full Name | Kendra Poole Inc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 334 Backbone Rd E, Princeton, Illinois |
| Authorized Official Name and Position | Kendra Mae Poole (FNP/ OWNER) |
| Authorized Official Contact | 8153034668 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kendra Poole Inc 2215 State St Peru IL 61354-3465 | Kendra Poole Inc 334 Backbone Rd E Princeton IL 61356-9685 Ph: (815) 303-4668 |
| NPI Number | 1831854744 |
|---|---|
| Provider Enumeration Date | 11/04/2021 |
| Last Update Date | 02/20/2025 |
| Certification Date | 02/20/2025 |
| Medicare PECOS PAC ID | 4385038322 |
|---|---|
| Medicare Enrollment ID | O20220308001498 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831854744 | NPI | - | NPPES |
| 1831854744 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| 363LF0000X | Nurse Practitioner - Family | () | Primary |
| Provider Name | Kendra Mae Poole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700480662 PECOS PAC ID: 4587072798 Enrollment ID: I20210427002526 |
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