Healthcare Provider Details

I. General information

NPI: 1073745519
Provider Name (Legal Business Name): AMY SUE PICKETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 GENESEE ST
UTICA NY
13501-4343
US

IV. Provider business mailing address

7786 TURIN RD
ROME NY
13440-2144
US

V. Phone/Fax

Practice location:
  • Phone: 315-507-5800
  • Fax: 315-507-5802
Mailing address:
  • Phone: 315-533-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number582339
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number582339
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number582339
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number582339
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: