Provider Demographics
NPI:1033636667
Name:LESLIE M. PICKETT MD PLLC
Entity Type:Organization
Organization Name:LESLIE M. PICKETT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-670-4730
Mailing Address - Street 1:1924 PINE ST STE 504
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2452
Mailing Address - Country:US
Mailing Address - Phone:325-670-4730
Mailing Address - Fax:325-670-4736
Practice Address - Street 1:1924 PINE ST STE 504
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2452
Practice Address - Country:US
Practice Address - Phone:325-670-4730
Practice Address - Fax:325-670-4736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3015207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty