Provider Demographics
NPI:1811729916
Name:POYNTER, MYCA
Entity type:Individual
Prefix:
First Name:MYCA
Middle Name:
Last Name:POYNTER
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 1:6427 TANTAMOUNT LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3539
Mailing Address - Country:US
Mailing Address - Phone:937-931-0002
Mailing Address - Fax:
Practice Address - Street 1:6427 TANTAMOUNT LN
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3539
Practice Address - Country:US
Practice Address - Phone:937-931-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide