Provider Demographics
NPI:1588279525
Name:PICKENS, MARQUITA MICHELLE (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARQUITA
Middle Name:MICHELLE
Last Name:PICKENS
Suffix:
Gender:F
Credentials:AGNP-C
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 29
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-0029
Mailing Address - Country:US
Mailing Address - Phone:225-485-5075
Mailing Address - Fax:
Practice Address - Street 1:17047 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2652
Practice Address - Country:US
Practice Address - Phone:225-485-5075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1006751363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health