MEDICARE: SAMANTHA ELIZABETH PICKETT CRNP

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
1	363LF0000X	Family Nurse Practitioner	1-087692	AL

General Provider Information

NPI Number	:	1063950319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ELIZABETH PICKETT CRNP

Provider Business Mailing Address
First Line	:	806 GLOVER AVE STE A
Second Line	:
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-2018
Country	:	US
Telephone Number	:	334-475-2680
Fax Number	:	334-475-2681

Provider Business Practice Location Address
First Line	:	806 GLOVER AVE STE A
Second Line	:
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-2018
Country	:	US
Telephone Number	:	334-475-2680
Fax Number	:	334-475-2681

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	05/18/2023

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