Provider Demographics
NPI:1659035319
Name:PICKLESIMER, AIMEE (CNA)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:PICKLESIMER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 ODESSA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-1125
Mailing Address - Country:US
Mailing Address - Phone:817-948-9222
Mailing Address - Fax:
Practice Address - Street 1:4317 ODESSA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-1125
Practice Address - Country:US
Practice Address - Phone:817-948-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA0060038311376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide