Healthcare Provider Details

I. General information

NPI: 1942124656
Provider Name (Legal Business Name): JEANENE MARIE PICKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 LIGHTHOUSE WAY
PERRYSBURG OH
43551-7053
US

IV. Provider business mailing address

7205 LIGHTHOUSE WAY
PERRYSBURG OH
43551-7053
US

V. Phone/Fax

Practice location:
  • Phone: 419-593-7050
  • Fax:
Mailing address:
  • Phone: 419-573-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: