Provider Demographics
NPI:1588006316
Name:PICKETTS, PIXIE (LMP)
Entity type:Individual
Prefix:
First Name:PIXIE
Middle Name:
Last Name:PICKETTS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:PIXIE
Other - Middle Name:I
Other - Last Name:PICKETTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:835 MOKULUA DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3107
Mailing Address - Country:US
Mailing Address - Phone:808-859-8088
Mailing Address - Fax:
Practice Address - Street 1:835 MOKULUA DR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3107
Practice Address - Country:US
Practice Address - Phone:808-859-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60141235225700000X
HIMAT-15311225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist