Healthcare Provider Details

I. General information

NPI: 1497618367
Provider Name (Legal Business Name): TERENCE MICHAEL PINKSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CROSSEN ST APT C
WEST WARWICK RI
02893-8823
US

IV. Provider business mailing address

34 CROSSEN ST APT C
WEST WARWICK RI
02893-8823
US

V. Phone/Fax

Practice location:
  • Phone: 417-459-6019
  • Fax:
Mailing address:
  • Phone: 417-459-6019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2025009194
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: