Provider Demographics
NPI:1194492942
Name:PINKSTON, LINDA CAROL
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROL
Last Name:PINKSTON
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 1:723 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3355
Mailing Address - Country:US
Mailing Address - Phone:248-252-4331
Mailing Address - Fax:
Practice Address - Street 1:723 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3355
Practice Address - Country:US
Practice Address - Phone:248-252-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker