Provider Demographics
NPI:1659687432
Name:PICKERING, ELIZABETH A (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:PICKERING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:A
Other - Last Name:PICKERING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321-0160
Mailing Address - Country:US
Mailing Address - Phone:217-357-8500
Mailing Address - Fax:217-357-8697
Practice Address - Street 1:1450 N COUNTY ROAD 2050 E
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:IL
Practice Address - Zip Code:62321-3551
Practice Address - Country:US
Practice Address - Phone:217-357-2173
Practice Address - Fax:217-357-3610
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60180643363A00000X
IL085007854363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0149PIOtherREGENCE
WA0268578OtherDEPT OF LABOR & INDUSTRIES