Provider Demographics
NPI:1174920441
Name:PICK, PATRICK R (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:R
Last Name:PICK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10190
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23450-0190
Mailing Address - Country:US
Mailing Address - Phone:800-477-5240
Mailing Address - Fax:757-216-1638
Practice Address - Street 1:8303 DODGE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4108
Practice Address - Country:US
Practice Address - Phone:402-354-5048
Practice Address - Fax:402-354-2585
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE2019363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025044400Medicaid
IA117492044Medicaid
NE099447009Medicare PIN