Provider Demographics
NPI:1588429807
Name:PINKLEY, ALLY
Entity type:Individual
Prefix:
First Name:ALLY
Middle Name:
Last Name:PINKLEY
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 1:1581 S COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-8402
Mailing Address - Country:US
Mailing Address - Phone:417-388-4603
Mailing Address - Fax:
Practice Address - Street 1:2711 S ROUSE ST STE B
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6621
Practice Address - Country:US
Practice Address - Phone:620-235-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-82901-32363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics