Provider Demographics
NPI:1740797679
Name:PICKNEY, JOVAN ANDRE I (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:JOVAN
Middle Name:ANDRE
Last Name:PICKNEY
Suffix:I
Gender:M
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWEGO
Mailing Address - State:LA
Mailing Address - Zip Code:70094-4012
Mailing Address - Country:US
Mailing Address - Phone:504-904-9906
Mailing Address - Fax:
Practice Address - Street 1:7605 WESTBANK EXPY STE D
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2367
Practice Address - Country:US
Practice Address - Phone:504-904-9906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-30
Last Update Date:2017-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management