Healthcare Provider Details

I. General information

NPI: 1023860723
Provider Name (Legal Business Name): KALEENA DENISE PICKETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 FM 407
DOUBLE OAK TX
75077-3031
US

IV. Provider business mailing address

8501 FM 407
DOUBLE OAK TX
75077-3031
US

V. Phone/Fax

Practice location:
  • Phone: 972-966-1980
  • Fax: 972-691-4937
Mailing address:
  • Phone: 972-966-1980
  • Fax: 972-691-4937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17616
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: