Provider Demographics
NPI:1962520742
Name:PINKERTON, ANDREW CLIFFORD (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CLIFFORD
Last Name:PINKERTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 W PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3511
Mailing Address - Country:US
Mailing Address - Phone:336-838-9553
Mailing Address - Fax:336-838-9563
Practice Address - Street 1:1915 W PARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3511
Practice Address - Country:US
Practice Address - Phone:336-838-9553
Practice Address - Fax:336-838-9563
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102623363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335816OtherMEDICARE PTAN, GROUP WPN
NCNC2753AOtherMEDICARE INDIVIDUAL, FOR WPN
NC2761082AMedicare Oscar/Certification
NCNC2753AOtherMEDICARE INDIVIDUAL, FOR WPN
NCQ24319Medicare UPIN