Provider Demographics
NPI:1275878324
Name:PICKETT, ANNA MARIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:MARIE
Last Name:PICKETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 REDWING RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6310
Mailing Address - Country:US
Mailing Address - Phone:970-631-8650
Mailing Address - Fax:833-909-3959
Practice Address - Street 1:2627 REDWING RD STE 300
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6310
Practice Address - Country:US
Practice Address - Phone:970-631-8650
Practice Address - Fax:833-909-3959
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA 3603363A00000X
CO3603363AM0700X
COPA.0003603363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38487705Medicaid