Basic Information
| Provider Information | |||||||||
| NPI: | 1538276290 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POINTON | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 QUEEN CITY AVE | ||||||||
| Address2: | |||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354012351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412650581 | ||||||||
| FaxNumber: | 5415746252 | ||||||||
| Practice Location | |||||||||
| Address1: | 36 SW NYE ST | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973653821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412654179 | ||||||||
| FaxNumber: | 5412654194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 01/25/2018 | ||||||||
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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 | 2084P0800X | 24771 | AL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | MD160151 | OR | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 70-320 | WI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 443BL | 01 | AL | EMPIRE BCBS PROVIDER # | OTHER | 051519855 | 01 | AL | BCBS PROVIDER NUMBER | OTHER | 0007796548 | 01 | AL | AETNA PROVIDER NUMBER | OTHER | 051519855 | 05 | AL | MEDICAID | 500651663 | 05 | OR | MEDICAID | 504900 | 01 | AL | VALUEOPTIONS PROVIDER # | OTHER |