Provider Demographics
NPI:1063844322
Name:PINNEY, SOFIE LAVINIA (DPM)
Entity type:Individual
Prefix:DR
First Name:SOFIE
Middle Name:LAVINIA
Last Name:PINNEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 KY HIGHWAY 36 E
Mailing Address - Street 2:STE G3
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7498
Mailing Address - Country:US
Mailing Address - Phone:606-218-6406
Mailing Address - Fax:606-218-7506
Practice Address - Street 1:1210 KY HIGHWAY 36 E
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7490
Practice Address - Country:US
Practice Address - Phone:859-235-3562
Practice Address - Fax:859-234-3967
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001227213E00000X
GA1063844322213E00000X, 213ES0103X, 213ES0131X
KY00447213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100410460Medicaid