MEDICARE: MISS ANNA MARIE PICKETT P.A.-C

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	363A00000X	Physician Assistant	PA 3603	CO
2	363AM0700X	Medical Physician Assistant	3603	CO
3	363A00000X	Physician Assistant	PA.0003603	CO

Other Identifiers

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

General Provider Information

NPI Number	:	1275878324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANNA MARIE PICKETT P.A.-C

Provider Business Mailing Address
First Line	:	2627 REDWING RD STE 300
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6310
Country	:	US
Telephone Number	:	970-631-8650
Fax Number	:	833-909-3959

Provider Business Practice Location Address
First Line	:	2627 REDWING RD STE 300
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6310
Country	:	US
Telephone Number	:	970-631-8650
Fax Number	:	833-909-3959

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

Provider Enumeration Date	:	11/30/2012
Last Update Date	:	11/30/2023

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Directions to “ MISS ANNA MARIE PICKETT P.A.-C” Practice Location

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