Provider Demographics
NPI:1174866636
Name:PICKERING, CHRISTOPHER G (NP)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:G
Last Name:PICKERING
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1401
Mailing Address - Country:US
Mailing Address - Phone:270-422-3400
Mailing Address - Fax:270-422-3473
Practice Address - Street 1:1010 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1401
Practice Address - Country:US
Practice Address - Phone:270-422-3400
Practice Address - Fax:270-422-3473
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1128804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily