Provider Demographics
NPI:1336503549
Name:PINKSTON, BRENIKA (CNA , HHA)
Entity Type:Individual
Prefix:
First Name:BRENIKA
Middle Name:
Last Name:PINKSTON
Suffix:
Gender:F
Credentials:CNA , HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 E SUTTENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46803-2491
Mailing Address - Country:US
Mailing Address - Phone:317-993-0476
Mailing Address - Fax:
Practice Address - Street 1:445 E SUTTENFIELD ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46803-2491
Practice Address - Country:US
Practice Address - Phone:317-993-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INHHA1200270374U00000X
INCNA1101623376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide