Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | APN001525 | NV |
Y | 363L00000X | Nurse Practitioner | APRN001525 | NV |
NPI | 1003250143 |
---|---|
Provider Name | Jann Stacey Pickens |
First Address | Philadelphia, PA 19101-3917 |
Second Address | Las Vegas, NV 89106-4119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2013 |
Last Update Date | 12/08/2020 |