Healthcare Provider Details

I. General information

NPI: 1326134156
Provider Name (Legal Business Name): EVANA DION PICKETT D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2694 THOMASVILLE RD
POCAHONTAS AR
72455-1202
US

IV. Provider business mailing address

PO BOX 582 2694 THOMASVILLE
POCAHONTAS AR
72455
US

V. Phone/Fax

Practice location:
  • Phone: 870-892-3337
  • Fax: 870-892-3337
Mailing address:
  • Phone: 870-892-3337
  • Fax: 870-892-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number1333
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: