Healthcare Provider Details

I. General information

NPI: 1669016713
Provider Name (Legal Business Name): PAMELA LATRESE PICKENS-TAYLOR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 OLD SHELL RD STE A
MOBILE AL
36608-2036
US

IV. Provider business mailing address

PO BOX 36258
BELFAST ME
04915-1204
US

V. Phone/Fax

Practice location:
  • Phone: 251-634-4589
  • Fax: 251-434-5047
Mailing address:
  • Phone: 251-318-2678
  • Fax: 251-405-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-115707
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: