Provider Demographics
NPI:1457692329
Name:PICARD, JACKI H
Entity Type:Individual
Prefix:MS
First Name:JACKI
Middle Name:H
Last Name:PICARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 CREEK BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8267
Mailing Address - Country:US
Mailing Address - Phone:803-412-2262
Mailing Address - Fax:
Practice Address - Street 1:635 KNIGHTON HILL RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9270
Practice Address - Country:US
Practice Address - Phone:803-981-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-02
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator