Provider Demographics
NPI:1063270379
Name:PICKETT, ELIZABETH EMMA (BSN, RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EMMA
Last Name:PICKETT
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:LUSK
Mailing Address - State:WY
Mailing Address - Zip Code:82225-0625
Mailing Address - Country:US
Mailing Address - Phone:307-340-2244
Mailing Address - Fax:
Practice Address - Street 1:414 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LUSK
Practice Address - State:WY
Practice Address - Zip Code:82225-5091
Practice Address - Country:US
Practice Address - Phone:307-340-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0183783163WH0200X, 163W00000X, 163WE0003X
MN2497130163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency