Individual
MARY PICKARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
407 S SCHWARTZ AVE, SUITE 202, FARMINGTON, NM 87401-5925
(505) 609-6770
(505) 609-6775
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2012-0034
NM
Other
Enumeration date
09/06/2012
Last updated
07/05/2017
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