Healthcare Provider Details

I. General information

NPI: 1336285428
Provider Name (Legal Business Name): PICKETT KENDALL JAMISON C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE BLDG CAP
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

PO BOX 64313
BALTIMORE MD
21264-4313
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-3099
  • Fax: 410-550-3027
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR167602
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: