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General NPI Number Information
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NPI Number | 1740141522
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Entity Type | Individual
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Provider Name | KENNETH DEWAYNE PICKENS
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Gender | Male
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 473 ELKS LODGE RD
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City | PAWHUSKA
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State | OK
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Zip | 74056-6542
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Country | US
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Telephone | 539-212-2499
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Fax | 539-212-2648
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Provider Business Mailing Address
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Address Line | 901 E 13TH ST
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City | PAWHUSKA
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State | OK
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Zip | 74056-2321
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Country | US
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Telephone | 918-287-9339
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | OK
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