Basic Information
| Provider Information | |||||||||
| NPI: | 1871131912 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PINKSTON | ||||||||
| FirstName: | WHITNIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LAT, ATC, OPE-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1802 23RD ST | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261013528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044880978 | ||||||||
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| Practice Location | |||||||||
| Address1: | 802 WAYNE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457503300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403746030 | ||||||||
| FaxNumber: | 7403746029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2019 | ||||||||
| LastUpdateDate: | 12/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/19/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT005300 | OH | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 246ZX2200X | 2209622 | Y |
No ID Information.