Provider Demographics
NPI:1265682009
Name:PICKETT, JENNIFER JOYCE (NP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOYCE
Last Name:PICKETT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JOYCE
Other - Last Name:WESTFALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:3447 ABES LANDING CT
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-1554
Mailing Address - Country:US
Mailing Address - Phone:432-770-2786
Mailing Address - Fax:
Practice Address - Street 1:1318 PALUXY RD
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5655
Practice Address - Country:US
Practice Address - Phone:817-594-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX679725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily