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General NPI Number Information
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NPI Number | 1689453656
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Entity Type | Individual
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Provider Name | HALEY MARIE PEACE PICKETT PA
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Gender | Female
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 705 E MARSHALL AVE STE 1002
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City | LONGVIEW
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State | TX
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Zip | 75601-5660
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Country | US
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Telephone | 903-759-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 8700 MILLICENT WAY APT 1505
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City | SHREVEPORT
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State | LA
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Zip | 71115-2264
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Country | US
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Telephone | 318-344-5035
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA17250
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 338744
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License Number State | LA
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