Provider Demographics
NPI:1740266071
Name:PICKETT, GAIL E (CRNP)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:E
Last Name:PICKETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 OLD FERN HILL RD.
Mailing Address - Street 2:BLDG. D, SUITE 600
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380
Mailing Address - Country:US
Mailing Address - Phone:610-692-3434
Mailing Address - Fax:610-692-9005
Practice Address - Street 1:915 OLD FERN HILL RD.
Practice Address - Street 2:BLDG. D, SUITE 600
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380
Practice Address - Country:US
Practice Address - Phone:610-692-3434
Practice Address - Fax:610-692-9005
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP001468G363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S76526Medicare UPIN
PA02126QWBMedicare ID - Type Unspecified