Provider Demographics
NPI:1598702896
Name:PICKETT, JAN (FNP)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:PICKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5935
Mailing Address - Country:US
Mailing Address - Phone:704-660-4567
Mailing Address - Fax:704-660-4585
Practice Address - Street 1:396 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5935
Practice Address - Country:US
Practice Address - Phone:704-660-4567
Practice Address - Fax:704-660-4585
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201026363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2591216Medicare ID - Type Unspecified
S69350Medicare UPIN