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General NPI Number Information
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NPI Number | 1720267560
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Entity Type | Individual
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Provider Name | SHANNON C PICKENS MD
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Gender | Female
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 3926 BARRON ST STE C208
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City | METAIRIE
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State | LA
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Zip | 70002-5797
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Country | US
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Telephone | 504-354-2064
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Fax |
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Provider Business Mailing Address
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Address Line | 18 RUE SAINT LOUIS
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City | KENNER
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State | LA
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Zip | 70065-1773
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Country | US
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Telephone | 504-234-3288
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD025591
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 025591
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License Number State | LA
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