Provider Demographics
NPI:1134589302
Name:PINKNEY, FREDRICK
Entity type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:
Last Name:PINKNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 CENTENARY BLVD
Mailing Address - Street 2:BUILDING 3 STE M2
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104
Mailing Address - Country:US
Mailing Address - Phone:318-221-7849
Mailing Address - Fax:318-675-0538
Practice Address - Street 1:2620 CENTENARY BLVD
Practice Address - Street 2:BUILDING 3 STE M2
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104
Practice Address - Country:US
Practice Address - Phone:318-221-7849
Practice Address - Fax:318-675-0538
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator