Chardonnay Nicole Poole, PSY.D.

Primary specialty

Forensic PsychologistTaxonomy code 103TF0200X

License

36008 Issued in TX

Practice address

2222 Western Trails Blvd Ste 202
Austin, TX 78745-1647

Phone

(512) 448-3221

NPI assigned

Oct 1, 2012

Last updated

Feb 10, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spraggins Psychological Services, PLLC

  • Clinical Psychologist
  • Austin, TX
  • NPI 1679965917
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1366793309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 WESTERN TRAILS BLVD STE 202",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787451647",
            "telephone_number": "512-448-3221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 WESTERN TRAILS BLVD STE 202",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787451647",
            "telephone_number": "512-448-3221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "CHARDONNAY",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-01",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "TX",
            "license": "36008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Macie Ponseigo
• Stephen Pont, MD, MPH
• Aishia Sherell Poole, RN
• Andrea Poole, RD
• Carolyn Poole, MED., LPC
• Donna M Poole, RN
• Laura Anne Poole, MS, OTR/L
• Michelle Marie Poole, RN, IBCLC
• Michelle Rarity Poole, RN, CNP
• Rex D Poole Jr., M.D.

• Forensic Psychologist in Austin, TX
• Providers in Austin, TX by specialty
• Forensic Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.