Healthcare Provider Details

I. General information

NPI: 1871131912
Provider Name (Legal Business Name): WHITNIE L PINKSTON LAT, ATC, OPE-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 WAYNE ST STE 200
MARIETTA OH
45750-3300
US

IV. Provider business mailing address

1802 23RD ST
PARKERSBURG WV
26101-3528
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-6030
  • Fax: 740-374-6029
Mailing address:
  • Phone: 304-488-0978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT005300
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number2209622
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: