Provider Demographics
NPI:1972569747
Name:PICKEL, JULIA L (PA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:L
Last Name:PICKEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7718
Mailing Address - Country:US
Mailing Address - Phone:512-863-4563
Mailing Address - Fax:
Practice Address - Street 1:1904 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7718
Practice Address - Country:US
Practice Address - Phone:512-863-4563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2657363AM0700X
TXPA00716363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ857386Medicaid
AZ106191Medicare ID - Type UnspecifiedMEDICARE NUMBER
AZ857386Medicaid