Provider Demographics
NPI:1760639850
Name:PICKENS, RYAN BAIRD (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:BAIRD
Last Name:PICKENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 ALCOA HWY
Mailing Address - Street 2:MOB B SUITE 222
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1502
Mailing Address - Country:US
Mailing Address - Phone:865-305-9254
Mailing Address - Fax:865-305-6133
Practice Address - Street 1:1928 ALCOA HWY
Practice Address - Street 2:MOB B SUITE 222
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1502
Practice Address - Country:US
Practice Address - Phone:865-305-9254
Practice Address - Fax:865-305-6133
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47346208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4350680OtherBCBS OF TN
TN1524084Medicaid
TN103I345893Medicare PIN