Healthcare Provider Details

I. General information

NPI: 1932163482
Provider Name (Legal Business Name): KIMBERLY PICKETT P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR NICU FLOOR
BRANDON FL
33511-5779
US

IV. Provider business mailing address

401 N PARSONS AVE SUITE 108B
BRANDON FL
33510-4538
US

V. Phone/Fax

Practice location:
  • Phone: 813-571-5360
  • Fax: 813-571-5242
Mailing address:
  • Phone: 813-643-7225
  • Fax: 813-643-5280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102843
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9102843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: