Healthcare Provider Details

I. General information

NPI: 1720267560
Provider Name (Legal Business Name): SHANNON C PICKENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3926 BARRON ST STE C208
METAIRIE LA
70002-5797
US

IV. Provider business mailing address

18 RUE SAINT LOUIS
KENNER LA
70065-1773
US

V. Phone/Fax

Practice location:
  • Phone: 504-354-2064
  • Fax:
Mailing address:
  • Phone: 504-234-3288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number025591
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD025591
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: