Provider Demographics
NPI:1255592200
Name:PICKNEY, LUCILLE MARY (MD)
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:MARY
Last Name:PICKNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2155
Mailing Address - Country:US
Mailing Address - Phone:361-573-6291
Mailing Address - Fax:361-576-2434
Practice Address - Street 1:1501 E MOCKINGBIRD LN
Practice Address - Street 2:SUITE 101
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2155
Practice Address - Country:US
Practice Address - Phone:361-573-6291
Practice Address - Fax:361-576-2434
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292963207L00000X
TXP1482207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
51262OtherABA PRIMARY CERTIFICATION
TX326366707Medicaid
51262OtherABA PRIMARY CERTIFICATION