Doctor Name: | TERESA KAYE PICKLE |
NPI Number: | 1649550708 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | MSR831167 |
Business Practice Address: | 14430 Main St Coffeeville, MS - 389222590 |
Business Phone Number: | 6626752500 |
Business Fax Number: | 6626752501 |
Mailing Address: | 14430 Main St, COFFEEVILLE |
State: | MS |
Postal Code: | 389222590 |
Phone Number: | 6626752500 |
Fax Number: | 6626752501 |
NPI Enumeration Date: | 08/22/2011 |
NPI Last Update Date: | 04/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | MSR831167 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |