Provider Demographics
NPI:1467650051
Name:PICKETT, LISA K (RRT, RCP, AE-C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:K
Last Name:PICKETT
Suffix:
Gender:F
Credentials:RRT, RCP, AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518-0467
Mailing Address - Country:US
Mailing Address - Phone:910-298-6007
Mailing Address - Fax:910-298-6009
Practice Address - Street 1:106 SOUTH BROWN RD
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518-0467
Practice Address - Country:US
Practice Address - Phone:910-298-6007
Practice Address - Fax:910-298-6009
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-407227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered