Healthcare Provider Details

I. General information

NPI: 1255160735
Provider Name (Legal Business Name): KATIE LYNN PICKENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 GRIFFIN AVE
EASTMAN GA
31023-6718
US

IV. Provider business mailing address

817 GRIFFIN AVE
EASTMAN GA
31023-6718
US

V. Phone/Fax

Practice location:
  • Phone: 478-374-1801
  • Fax: 478-448-4586
Mailing address:
  • Phone: 478-374-1801
  • Fax: 478-448-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6461572
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP004365
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: