Provider Demographics
NPI:1366531964
Name:PICKEL, MARJORIE CAROLANNE (NP)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:CAROLANNE
Last Name:PICKEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 DUNHILL PL NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3885
Mailing Address - Country:US
Mailing Address - Phone:423-472-0459
Mailing Address - Fax:423-472-0493
Practice Address - Street 1:103 DONNER DR
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830
Practice Address - Country:US
Practice Address - Phone:865-685-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7782363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100041600OtherPHP TENNCARE
TN1532620Medicaid
TNP00154886OtherTRAVELERS MEDICARE
TN1532620Medicaid
TN3633584Medicare PIN