Provider Demographics
NPI:1689184939
Name:PICKENS, MARGO CAITLIN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARGO
Middle Name:CAITLIN
Last Name:PICKENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:MARGO
Other - Middle Name:CAITLIN
Other - Last Name:MILLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 KEETON DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-8756
Mailing Address - Country:US
Mailing Address - Phone:270-719-1100
Mailing Address - Fax:
Practice Address - Street 1:2955 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4901
Practice Address - Country:US
Practice Address - Phone:270-632-1548
Practice Address - Fax:270-632-1572
Is Sole Proprietor?:No
Enumeration Date:2017-10-01
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3011322OtherKENTUCKY APRN NURSE PRACTITIONER LICENSE
F03170114OtherAANP CERTIFICATION BOARD