Healthcare Provider Details

I. General information

NPI: 1598740839
Provider Name (Legal Business Name): STEPHANIE PICKETT ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BROOKVIEW HILLS BLVD SUITE 107 TOTAL FAMILY CARE OF WINSTON SALEM
WINSTON-SALEM NC
27103-5661
US

IV. Provider business mailing address

1474 FINWICK DR
PFAFFTOWN NC
27040-9031
US

V. Phone/Fax

Practice location:
  • Phone: 336-760-8380
  • Fax: 336-760-8388
Mailing address:
  • Phone: 336-922-6786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number900280
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: