Provider Demographics
NPI:1437205457
Name:PRICKETT, MARY ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:PRICKETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1201 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2233
Mailing Address - Country:US
Mailing Address - Phone:559-685-4622
Mailing Address - Fax:559-686-2375
Practice Address - Street 1:1101 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2231
Practice Address - Country:US
Practice Address - Phone:559-686-9097
Practice Address - Fax:559-685-4635
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7423363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology