Provider Demographics
NPI:1740435288
Name:BALES-POIROT, DEIDRE LEANN (APRN, CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:LEANN
Last Name:BALES-POIROT
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:MRS
Other - First Name:DEIDRE
Other - Middle Name:LEANN
Other - Last Name:BALES-POIROT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CNPN-PC
Mailing Address - Street 1:301 MANCHESTER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 MANCHESTER RD STE 105
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2587
Practice Address - Country:US
Practice Address - Phone:845-452-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN206703163W00000X
OKR0101133163W00000X
MO2004014988163W00000X, 363LP0200X
NY815916163W00000X
OKR0101131363LP0200X
AZAP10033363LP0200X
NYF383232363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse