Provider Demographics
NPI:1073745519
Name:PICKETT, AMY SUE (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUE
Last Name:PICKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7786 TURIN RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2144
Mailing Address - Country:US
Mailing Address - Phone:315-533-6701
Mailing Address - Fax:
Practice Address - Street 1:1411 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4343
Practice Address - Country:US
Practice Address - Phone:315-507-5800
Practice Address - Fax:315-507-5802
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY582339163W00000X, 163WA0400X, 163WM0705X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation