Provider Demographics
NPI:1427146174
Name:PICKREN, CRAIG WRIGLEY (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WRIGLEY
Last Name:PICKREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 BATES ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-6910
Mailing Address - Country:US
Mailing Address - Phone:870-262-1200
Mailing Address - Fax:870-262-6088
Practice Address - Street 1:1710 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7303
Practice Address - Country:US
Practice Address - Phone:870-262-1200
Practice Address - Fax:870-262-6088
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6653207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR54063Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER