Provider Demographics
NPI: | 1801861349 |
---|---|
Name: | POINDEXTER, PATRICIA R (CNS) |
Entity Type: | Individual |
Prefix: | |
First Name: | PATRICIA |
Middle Name: | R |
Last Name: | POINDEXTER |
Suffix: | |
Gender: | F |
Credentials: | CNS |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 202 MYERS RD |
Mailing Address - Street 2: | SUITE 500 |
Mailing Address - City: | DANVILLE |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46122-9702 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-718-8436 |
Mailing Address - Fax: | 317-718-8438 |
Practice Address - Street 1: | 6291 CAMBRIDGE WAY STE 200 |
Practice Address - Street 2: | |
Practice Address - City: | PLAINFIELD |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46168-7905 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-718-8436 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-02-20 |
Last Update Date: | 2023-08-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 70000159A | 364SP0807X, 364SP0808X, 364SP0810X, 364SP0812X, 364SS0200X, 363LP0808X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |
No | 364SP0807X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Adolescent |
No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health |
No | 364SP0810X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Family |
No | 364SP0812X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Community |
No | 364SS0200X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | School |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 000000724785 | Other | ANTHEM BCBS |
IN | 100270530 | Medicaid | |
IN | 150074 | Medicare PIN |