MEDICARE: MR. ANTHONY EUGENE PINCKNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	001011661	TX
2	101Y00000X	Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	3104A0625X	Assisted Living Facility (Mental Illness)	001011661	TX
5	385H00000X	Respite Care	001011661	TX

General Provider Information

NPI Number	:	1487514295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY EUGENE PINCKNEY

Provider Business Mailing Address
First Line	:	3612 ADA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-3422
Country	:	US
Telephone Number	:	682-230-5417
Fax Number	:	817-547-0023

Provider Business Practice Location Address
First Line	:	3612 ADA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-3422
Country	:	US
Telephone Number	:	682-230-5417
Fax Number	:	817-547-0023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2025
Last Update Date	:	01/23/2026

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