Healthcare Provider Details

I. General information

NPI: 1972970838
Provider Name (Legal Business Name): JEAN PINKARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OWEN ST UNIT #56
BELLEVILLE MI
48111-2921
US

IV. Provider business mailing address

27835 BERRYWOOD LN UNIT #56
FARMINGTON HILLS MI
48334-4053
US

V. Phone/Fax

Practice location:
  • Phone: 734-699-5400
  • Fax: 734-699-5455
Mailing address:
  • Phone: 248-790-5205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704164057
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: