Provider Demographics
NPI:1639468382
Name:PINKSTON, OLGA C (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:C
Last Name:PINKSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 PARK PLAZA AVE UNIT 106
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2289
Mailing Address - Country:US
Mailing Address - Phone:502-429-6049
Mailing Address - Fax:
Practice Address - Street 1:9720 PARK PLAZA AVE UNIT 106
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2289
Practice Address - Country:US
Practice Address - Phone:502-429-6049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46987207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100213070Medicaid
KY7100213070Medicaid