MEDICARE: BRIANNA NICOLE POCKETTE 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	0010-12012	NC

General Provider Information

NPI Number	:	1881349215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA NICOLE POCKETTE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1845
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28687-1845
Country	:	US
Telephone Number	:	704-873-4277
Fax Number	:

Provider Business Practice Location Address
First Line	:	2660 TATE BLVD SE STE 202
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-1466
Country	:	US
Telephone Number	:	704-978-1145
Fax Number	:

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

Provider Enumeration Date	:	02/15/2022
Last Update Date	:	08/15/2023

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