Provider Demographics
NPI:1699239418
Name:PICKETT, CHARLOTTE MARRIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:MARRIE
Last Name:PICKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6294E ST HWY 69
Mailing Address - Street 2:
Mailing Address - City:ALBA
Mailing Address - State:TX
Mailing Address - Zip Code:75410
Mailing Address - Country:US
Mailing Address - Phone:903-513-0457
Mailing Address - Fax:
Practice Address - Street 1:6294 E ST HWY 69
Practice Address - Street 2:
Practice Address - City:ALBA
Practice Address - State:TX
Practice Address - Zip Code:75410
Practice Address - Country:US
Practice Address - Phone:903-513-0457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily