MEDICARE: KATHERINE STOKES PICKETT PA-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	104029	NC

General Provider Information

NPI Number	:	1366640807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE STOKES PICKETT PA-C

Provider Business Mailing Address
First Line	:	3511 W MARKET ST
Second Line	:	SUITE A
City	:	GREENSBORO
State	:	NC
Zip	:	27403-4442
Country	:	US
Telephone Number	:	336-852-3800
Fax Number	:	336-852-5725

Provider Business Practice Location Address
First Line	:	3511 W MARKET ST
Second Line	:	SUITE A
City	:	GREENSBORO
State	:	NC
Zip	:	27403-4442
Country	:	US
Telephone Number	:	336-852-3800
Fax Number	:	336-852-5725

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

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	08/03/2010

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