Provider Demographics
NPI:1699052704
Name:PICKETT, JOYCE A (RD, LD)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:A
Last Name:PICKETT
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:A
Other - Last Name:NUESKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 E STONER AVE, OVERTON BROOKS VAMC
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101
Mailing Address - Country:US
Mailing Address - Phone:318-221-8400
Mailing Address - Fax:318-990-5724
Practice Address - Street 1:510 E STONER AVE, OVERTON BROOKS VAMC
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-221-8400
Practice Address - Fax:318-990-5724
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.00556133V00000X
LA2593133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered