Provider Demographics
NPI:1720472053
Name:PICKETT, JONATHAN ERNEST (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ERNEST
Last Name:PICKETT
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:CMR 480 BOX 1729
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09128
Mailing Address - Country:US
Mailing Address - Phone:496-371-9464
Mailing Address - Fax:
Practice Address - Street 1:U.S. ARMY HEALTH CLINIC STUTTGART
Practice Address - Street 2:UNIT 30401, PATCH BARRACKS, GERMANY
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09154
Practice Address - Country:US
Practice Address - Phone:253-968-2825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE29434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine