Provider Demographics
NPI:1992316426
Name:PINCKNEY, KRYSTAL L (CTRS)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:L
Last Name:PINCKNEY
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4093
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-0001
Mailing Address - Country:US
Mailing Address - Phone:804-309-6767
Mailing Address - Fax:
Practice Address - Street 1:13918 SEATTLE SLEW LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-1538
Practice Address - Country:US
Practice Address - Phone:804-309-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
53020225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No374J00000XNursing Service Related ProvidersDoula