Provider Demographics
NPI:1609873132
Name:PICKETT, KAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:PICKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STAGECOACH VLG STE 3
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-4751
Mailing Address - Country:US
Mailing Address - Phone:501-907-5595
Mailing Address - Fax:501-907-5599
Practice Address - Street 1:1 STAGECOACH VILLAGE
Practice Address - Street 2:SUITE 3
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210
Practice Address - Country:US
Practice Address - Phone:501-907-5595
Practice Address - Fax:501-907-5599
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-7518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080195110OtherRAILROAD MEDICARE
AR11211000000OtherQUALCHOICE
01-20301OtherUNITED HEALTHCARE
E15124Medicare UPIN