Healthcare Provider Details

I. General information

NPI: 1952185050
Provider Name (Legal Business Name): KEITHA LATRICE PINCKNEY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E PALMDALE BLVD
PALMDALE CA
93550-4598
US

IV. Provider business mailing address

320 E PALMDALE BLVD
PALMDALE CA
93550-4598
US

V. Phone/Fax

Practice location:
  • Phone: 818-654-3887
  • Fax:
Mailing address:
  • Phone: 818-654-3887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95085009
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: