Provider Demographics
NPI:1710033238
Name:PILKENTON, JODIE SUE
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:SUE
Last Name:PILKENTON
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 1:245 ALTAIR AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-1423
Mailing Address - Country:US
Mailing Address - Phone:805-348-1850
Mailing Address - Fax:805-348-1856
Practice Address - Street 1:305 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-5006
Practice Address - Country:US
Practice Address - Phone:805-348-1850
Practice Address - Fax:805-348-1856
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770665887Medicare UPIN