Provider Demographics
NPI:1194183038
Name:PINKERTON, KATRINA (NP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:PINKERTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 AEGEAN WAY
Mailing Address - Street 2:#266
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4071
Mailing Address - Country:US
Mailing Address - Phone:707-592-9534
Mailing Address - Fax:
Practice Address - Street 1:3727 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-1112
Practice Address - Country:US
Practice Address - Phone:503-778-7273
Practice Address - Fax:503-788-7285
Is Sole Proprietor?:No
Enumeration Date:2016-02-07
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201605528NP-PP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health