Provider Demographics
NPI:1851152821
Name:POINTER, MARKIDA SHI'DAE
Entity Type:Individual
Prefix:
First Name:MARKIDA
Middle Name:SHI'DAE
Last Name:POINTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 PEATMOSS DR APT A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-8995
Mailing Address - Country:US
Mailing Address - Phone:256-493-4052
Mailing Address - Fax:
Practice Address - Street 1:6408 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7977
Practice Address - Country:US
Practice Address - Phone:910-878-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant