Ms Miranda Jalene Pool, PHYSICIAN ASSISTANT is a medicare enrolled "Physician Assistant" provider in Winnebago, Wisconsin. Her current practice location is
1300 South Drive, Winnebago, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(920) 235-4910.
Ms Miranda Jalene Pool is licensed to practice in Wisconsin (license number 4641) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1649425091.
Healthcare Provider's Profile
Full Name | Ms Miranda Jalene Pool |
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Gender | Female |
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Speciality | Physician Assistant |
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Location | 1300 South Drive, Winnebago, Wisconsin |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1649425091
- Provider Enumeration Date: 11/26/2008
- Last Update Date: 06/30/2023
Medicare PECOS Information:
- PECOS PAC ID: 7214247311
- Enrollment ID: I20170329001065
Medical Identifiers
Medical identifiers for Ms Miranda Jalene Pool such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1649425091 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101YP2500X | Counselor - Professional | 63151 (Texas) | Secondary |
363A00000X | Physician Assistant | (Texas) | Secondary |
363A00000X | Physician Assistant | 4641 (Wisconsin) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ms Miranda Jalene Pool is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Ms Miranda Jalene Pool, PHYSICIAN ASSISTANT 17819 Red River Canyon Dr, Humble, TX 77346-3543 Ph: (832) 810-0200 | Ms Miranda Jalene Pool, PHYSICIAN ASSISTANT 1300 South Drive, Winnebago, WI 54985-5498 Ph: (920) 235-4910 |
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