Healthcare Provider Details

I. General information

NPI: 1851762421
Provider Name (Legal Business Name): RYAN PICKERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CLEARVIEW PKWY
METAIRIE LA
70001-3419
US

IV. Provider business mailing address

3106 UPPERLINE ST
NEW ORLEANS LA
70125-5043
US

V. Phone/Fax

Practice location:
  • Phone: 504-736-4800
  • Fax:
Mailing address:
  • Phone: 561-202-4732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: