Provider Demographics
NPI:1104813591
Name:POINDEXTER, NOEL GERARD (MSN-CRNA)
Entity type:Individual
Prefix:MR
First Name:NOEL
Middle Name:GERARD
Last Name:POINDEXTER
Suffix:
Gender:M
Credentials:MSN-CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:865-771-0919
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:865-771-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN134650367500000X
OKR0090672367500000X
TN1115186367500000X
TN10380367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000323888OtherBLUE CROSS/BLUE SHIELD
OK20021868AMedicaid
TN4023048OtherBLUE CROSS/BLUE SHIELD
TN4023048OtherBLUE CROSS OF TN
P00632200OtherRAILROAD MEDICARE PIN
TN3630138Medicaid
KY74005836Medicaid
KY000000323888OtherBCBS OF KY
KY74005836Medicaid
OKOK401096Medicare PIN
OK20021868AMedicaid
OK$$$$$$$$$001OtherBLUE CROSS/BLUE SHIELD
TN4023048OtherBLUE CROSS OF TN