Provider Demographics
NPI:1831667948
Name:PICKLE, HEATHER MARIE (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:PICKLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1424 N EXPRESSWAY STE 121-123
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-1753
Mailing Address - Country:US
Mailing Address - Phone:678-688-2820
Mailing Address - Fax:770-467-9868
Practice Address - Street 1:1424 N EXPRESSWAY STE 121-123
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1753
Practice Address - Country:US
Practice Address - Phone:678-688-2820
Practice Address - Fax:770-467-9868
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN230659363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner