Provider Demographics
NPI:1265295224
Name:PICKETT, ALACIA CEONDRA (RN)
Entity type:Individual
Prefix:
First Name:ALACIA
Middle Name:CEONDRA
Last Name:PICKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-7545
Mailing Address - Country:US
Mailing Address - Phone:803-402-5631
Mailing Address - Fax:
Practice Address - Street 1:524 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-8644
Practice Address - Country:US
Practice Address - Phone:803-581-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC270005163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice