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General NPI Number Information
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NPI Number | 1770351769
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Entity Type | Individual
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Provider Name | JAKE PICKENS CRNP
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Gender | Male
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 1728 11TH AVE
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City | HALEYVILLE
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State | AL
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Zip | 35565-1506
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Country | US
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Telephone | 205-485-7822
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Fax | 833-449-4072
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Provider Business Mailing Address
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Address Line | 1728 11TH AVE
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City | HALEYVILLE
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State | AL
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Zip | 35565-1506
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Country | US
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Telephone | 205-485-7822
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Fax | 833-449-4072
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-170309
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 1-170309
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License Number State | AL
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