Provider Demographics
NPI:1780854042
Name:ANGELA L. PINKSTON-AYSON, DPM
Entity Type:Organization
Organization Name:ANGELA L. PINKSTON-AYSON, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:AYSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:479-636-3668
Mailing Address - Street 1:11 HALSTED CIR STE E
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3145
Mailing Address - Country:US
Mailing Address - Phone:479-636-3668
Mailing Address - Fax:479-636-6806
Practice Address - Street 1:11 HALSTED CIR STE E
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3145
Practice Address - Country:US
Practice Address - Phone:479-636-3668
Practice Address - Fax:479-636-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR166213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU68719Medicare UPIN
4304210001Medicare NSC