MEDICARE: TARA B PICKENS FNP-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	363LF0000X	Family Nurse Practitioner	APRN.CNP.019354	OH

General Provider Information

NPI Number	:	1487006912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA B PICKENS FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 449
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-0449
Country	:	US
Telephone Number	:	740-374-4500
Fax Number	:	740-374-5887

Provider Business Practice Location Address
First Line	:	400 MATTHEW ST STE 303
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-1656
Country	:	US
Telephone Number	:	740-373-7828
Fax Number	:	740-373-5898

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

Provider Enumeration Date	:	07/08/2016
Last Update Date	:	04/14/2026

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