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SHJUAN D PICKETT-CROCKETT

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1619371614

Individual Registrant:
 SHJUAN D PICKETT-CROCKETT 
Gender: F
Not Sole Proprietor

Location and contact information for practice:
1768 S WASHINGTON ST  MARION, AL 36756-3406 US
Tel: 334-682-9085  Fax: 334-682-9082

Contact information for business:
1768 S WASHINGTON ST  MARION, AL 36756-3406 US
Tel: 334-682-9086  Fax: 334-682-9082

Registration Information:
NPI: 1619371614
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
AL1-113983

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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