Provider Demographics
NPI:1326305863
Name:PICKENS, MEKEISHA RENAE (MD)
Entity Type:Individual
Prefix:
First Name:MEKEISHA
Middle Name:RENAE
Last Name:PICKENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 9TH AVE SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-4530
Mailing Address - Country:US
Mailing Address - Phone:205-481-1886
Mailing Address - Fax:205-481-9034
Practice Address - Street 1:1090 9TH AVE SW
Practice Address - Street 2:SUITE 100
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4530
Practice Address - Country:US
Practice Address - Phone:205-481-1886
Practice Address - Fax:205-481-9034
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL33034208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51163252OtherBLUE CROSS BLUE SHIELD
AL511-63278OtherBLUE CROSS
AL173148Medicaid
AL173945Medicaid