Healthcare Provider Details

I. General information

NPI: 1710937289
Provider Name (Legal Business Name): BETH ANNE PICKENS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 N CAPITOL AVE STE 236
INDIANAPOLIS IN
46202-1262
US

IV. Provider business mailing address

3401 E RAYMOND ST
INDIANAPOLIS IN
46203-4744
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-8067
  • Fax: 317-963-5038
Mailing address:
  • Phone: 317-781-4900
  • Fax: 317-781-4868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001328A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: