Provider Demographics
NPI:1043755705
Name:POINDEXTER, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:POINDEXTER
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 1:112 S CROCKER CT
Mailing Address - Street 2:
Mailing Address - City:COLWICH
Mailing Address - State:KS
Mailing Address - Zip Code:67030-8843
Mailing Address - Country:US
Mailing Address - Phone:316-304-9945
Mailing Address - Fax:
Practice Address - Street 1:112 S CROCKER CT
Practice Address - Street 2:
Practice Address - City:COLWICH
Practice Address - State:KS
Practice Address - Zip Code:67030-8843
Practice Address - Country:US
Practice Address - Phone:316-304-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77489-021364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health