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
StateLicense IDTaxonomies
IN70000159A364SP0807X, 364SP0808X, 364SP0810X, 364SP0812X, 364SS0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
No364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Community
No364SS0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000724785OtherANTHEM BCBS
IN100270530Medicaid
IN150074Medicare PIN