Basic Information
| Provider Information | |||||||||
| NPI: | 1164837613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PINKSTON | ||||||||
| FirstName: | KRISTEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1944 FM 711 | ||||||||
| Address2: | |||||||||
| City: | CENTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759356852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9363323905 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 TROUP HWY EPIC PEDIATRIC THERAPY | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757018397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9032530095 | ||||||||
| FaxNumber: | 9035093744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2014 | ||||||||
| LastUpdateDate: | 06/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 110203 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.