Provider Demographics
NPI:1477343044
Name:PRICKETT, MARY CATHERINE (AG-ACNP-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:PRICKETT
Suffix:
Gender:
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 LYNDHURST RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-5225
Mailing Address - Country:US
Mailing Address - Phone:214-336-5768
Mailing Address - Fax:
Practice Address - Street 1:1 AUTUMN CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:VA
Practice Address - Zip Code:22727-3028
Practice Address - Country:US
Practice Address - Phone:540-948-3054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188932363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner