Provider Demographics
NPI:1982572269
Name:PICHARDO LEBRON, ROSA M
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:PICHARDO LEBRON
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 1:5707 POPE ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7226
Mailing Address - Country:US
Mailing Address - Phone:978-677-8563
Mailing Address - Fax:
Practice Address - Street 1:5707 POPE ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-7226
Practice Address - Country:US
Practice Address - Phone:978-677-8563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF09251383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily