Provider Demographics
NPI:1063950319
Name:PICKETT, SAMANTHA ELIZABETH (CRNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELIZABETH
Last Name:PICKETT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 GLOVER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2018
Mailing Address - Country:US
Mailing Address - Phone:334-475-2680
Mailing Address - Fax:334-475-2681
Practice Address - Street 1:806 GLOVER AVE STE A
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2018
Practice Address - Country:US
Practice Address - Phone:334-475-2680
Practice Address - Fax:334-475-2681
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-087692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily