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NPI Code Detail

MEDICARE: MR. LARRY MICHAEL PICKETT CRNA

MEDICARE: MR. LARRY MICHAEL PICKETT CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistAPRN.CRNA.08426OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063413813
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LARRY MICHAEL PICKETT CRNA
Provider Business Mailing Address
First Line : 433 W HIGH ST
Second Line :
City : BRYAN
State : OH
Zip : 43506-1690
Country : US
Telephone Number : 419-636-1131
Fax Number : 419-636-3100
Provider Business Practice Location Address
First Line : 433 W HIGH ST
Second Line :
City : BRYAN
State : OH
Zip : 43506-1690
Country : US
Telephone Number : 419-636-1131
Fax Number : 419-636-3100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 07/17/2020

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