Healthcare Provider Details

I. General information

NPI: 1801861349
Provider Name (Legal Business Name): PATRICIA R POINDEXTER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6291 CAMBRIDGE WAY STE 200
PLAINFIELD IN
46168-7905
US

IV. Provider business mailing address

202 MYERS RD SUITE 500
DANVILLE IN
46122-9702
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-8436
  • Fax:
Mailing address:
  • Phone: 317-718-8436
  • Fax: 317-718-8438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number70000159A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number70000159A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number70000159A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number70000159A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code364SS0200X
TaxonomySchool Clinical Nurse Specialist
License Number70000159A
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number70000159A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000000724785
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerANTHEM BCBS
# 2
Identifier100270530
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: