Basic Information
| Provider Information | |||||||||
| NPI: | 1780744037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POINDEXTER | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 640 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE RAPIDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278700640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525365440 | ||||||||
| FaxNumber: | 2525365444 | ||||||||
| Practice Location | |||||||||
| Address1: | 2066 NC HIGHWAY 125 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE RAPIDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525365000 | ||||||||
| FaxNumber: | 2525362258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2006 | ||||||||
| LastUpdateDate: | 11/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN154259NP | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 201502279NP-PP | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 5010707 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.