Healthcare Provider Details

I. General information

NPI: 1013163013
Provider Name (Legal Business Name): MARLA KAY ENGLISH-PICKETT GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16060 BROADLEAF
TEXARKANA TX
75503-9607
US

IV. Provider business mailing address

16060 BROADLEAF
TEXARKANA TX
75503-9607
US

V. Phone/Fax

Practice location:
  • Phone: 903-838-0031
  • Fax:
Mailing address:
  • Phone: 903-838-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number565703
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number55703
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: