Healthcare Provider Details

I. General information

NPI: 1720472053
Provider Name (Legal Business Name): JONATHAN ERNEST PICKETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 12/26/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. ARMY HEALTH CLINIC STUTTGART UNIT 30401, PATCH BARRACKS, GERMANY
APO AE
09154
US

IV. Provider business mailing address

CMR 480 BOX 1729
APO AE
09128
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2825
  • Fax:
Mailing address:
  • Phone: 496-371-9464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29434
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: