Healthcare Provider Details

I. General information

NPI: 1841567468
Provider Name (Legal Business Name): NATHAN PICKEL MED, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10408 HADDINGTON DR NW
CHARLOTTE NC
28269-6955
US

IV. Provider business mailing address

10408 HADDINGTON DR NW
CHARLOTTE NC
28269-6955
US

V. Phone/Fax

Practice location:
  • Phone: 618-237-8502
  • Fax:
Mailing address:
  • Phone: 618-237-8502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2014
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: