Healthcare Provider Details

I. General information

NPI: 1740435288
Provider Name (Legal Business Name): DEIDRE LEANN BALES-POIROT APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEIDRE LEANN BALES-POIROT APRN, CNPN-PC

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MANCHESTER RD STE 105
POUGHKEEPSIE NY
12603-2587
US

IV. Provider business mailing address

301 MANCHESTER RD STE 105
POUGHKEEPSIE NY
12603-2587
US

V. Phone/Fax

Practice location:
  • Phone: 845-452-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN206703
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0101133
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2004014988
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number815916
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2004014988
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR0101131
License Number StateOK
# 7
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP10033
License Number StateAZ
# 8
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF383232
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: