Healthcare Provider Details

I. General information

NPI: 1093830242
Provider Name (Legal Business Name): MICHAEL TODD PICKETT RN, CPNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST SIUTE A210
HOUSTON TX
77030-2303
US

IV. Provider business mailing address

607 BISCAYNE BEND LN
LEAGUE CITY TX
77573-6219
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-6298
  • Fax:
Mailing address:
  • Phone: 281-554-7593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number20020358
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: