Provider Demographics
NPI:1164837613
Name:PINKSTON, KRISTEN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:PINKSTON
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 1:1944 FM 711
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-6852
Mailing Address - Country:US
Mailing Address - Phone:936-332-3905
Mailing Address - Fax:
Practice Address - Street 1:3200 TROUP HWY EPIC PEDIATRIC THERAPY
Practice Address - Street 2:SUITE 120
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8397
Practice Address - Country:US
Practice Address - Phone:903-253-0095
Practice Address - Fax:903-509-3744
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist