Provider Demographics
NPI:1821069790
Name:PICKETT, HOWARD ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:ANDREW
Last Name:PICKETT
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 1:1236 N JESSE JAMES RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1119
Mailing Address - Country:US
Mailing Address - Phone:816-637-8900
Mailing Address - Fax:816-637-4011
Practice Address - Street 1:1236 N JESSE JAMES RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1119
Practice Address - Country:US
Practice Address - Phone:816-637-8900
Practice Address - Fax:816-637-4011
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6C90207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00215637OtherMEDICARE RR
MO201487311Medicaid
MOE05029Medicare UPIN
MOP00215637OtherMEDICARE RR