Provider Demographics
NPI:1376896530
Name:PINKERTON, JAYLENE RAE (LPN)
Entity Type:Individual
Prefix:
First Name:JAYLENE
Middle Name:RAE
Last Name:PINKERTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JAYLENE
Other - Middle Name:R
Other - Last Name:PINKERTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:517 N TERRY AVE
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-1630
Mailing Address - Country:US
Mailing Address - Phone:406-672-5554
Mailing Address - Fax:
Practice Address - Street 1:517 N TERRY AVE
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-1630
Practice Address - Country:US
Practice Address - Phone:406-672-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT33918164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse