Healthcare Provider Details

I. General information

NPI: 1164113692
Provider Name (Legal Business Name): EUGENIA RENEE POINDEXTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 S 8TH ST
BEAUMONT TX
77701-7719
US

IV. Provider business mailing address

2750 S 8TH ST
BEAUMONT TX
77701-7719
US

V. Phone/Fax

Practice location:
  • Phone: 409-839-1000
  • Fax:
Mailing address:
  • Phone: 409-839-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1109775
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: