Healthcare Provider Details

I. General information

NPI: 1609740406
Provider Name (Legal Business Name): BRIANNA SLOAN PICKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 EARL FRYE BLVD # A
AMORY MS
38821-5507
US

IV. Provider business mailing address

30263 HIGHWAY 371
AMORY MS
38821-7810
US

V. Phone/Fax

Practice location:
  • Phone: 662-256-9331
  • Fax:
Mailing address:
  • Phone: 662-640-5356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907825
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: