Provider Demographics
NPI:1366640807
Name:PICKETT, KATHERINE STOKES (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:STOKES
Last Name:PICKETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:STOKES
Other - Last Name:MEISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3511 W MARKET ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-4442
Mailing Address - Country:US
Mailing Address - Phone:336-852-3800
Mailing Address - Fax:336-852-5725
Practice Address - Street 1:3511 W MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-4442
Practice Address - Country:US
Practice Address - Phone:336-852-3800
Practice Address - Fax:336-852-5725
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104029363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2769800Medicare PIN
NC2762614BMedicare PIN
Q34407Medicare UPIN