Provider Demographics
NPI:1477095321
Name:POINDEXTER, KRYSTAL (CNP)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17901 GOVERNORS HWY
Mailing Address - Street 2:ST 201
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1144
Mailing Address - Country:US
Mailing Address - Phone:708-960-4280
Mailing Address - Fax:708-960-0390
Practice Address - Street 1:17901 GOVERNORS HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1144
Practice Address - Country:US
Practice Address - Phone:708-960-4280
Practice Address - Fax:708-960-0390
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily