Provider Demographics
NPI:1497297436
Name:PICKEREL, JAMES (HIS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PICKEREL
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2231
Mailing Address - Country:US
Mailing Address - Phone:785-740-4327
Mailing Address - Fax:816-676-2901
Practice Address - Street 1:618 OREGON ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2231
Practice Address - Country:US
Practice Address - Phone:785-740-4327
Practice Address - Fax:816-676-2901
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1668174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist