Healthcare Provider Details

I. General information

NPI: 1609152347
Provider Name (Legal Business Name): JARED PICKNEY MHPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ROCKINGCHAIR RD STE 1-3
PARAGOULD AR
72450-2413
US

IV. Provider business mailing address

100 N ROCKINGCHAIR RD STE 1-3
PARAGOULD AR
72450-2413
US

V. Phone/Fax

Practice location:
  • Phone: 870-335-9617
  • Fax: 870-335-9618
Mailing address:
  • Phone: 870-335-9617
  • Fax: 870-335-9618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: