Provider Demographics
NPI:1952808149
Name:PICKRELL, DANIEL JOHN (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:PICKRELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 VIDA VERDE LN NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1609
Mailing Address - Country:US
Mailing Address - Phone:520-491-9874
Mailing Address - Fax:
Practice Address - Street 1:4216 VIDA VERDE LN NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1609
Practice Address - Country:US
Practice Address - Phone:435-709-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11405456-12042084P0800X
NMDO2023-01792084P0802X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry