Individual
TRAVIS M PICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2325 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 557-2700
Mailing address
PO BOX 3206, IDAHO FALLS, ID 83403-3206
(208) 523-4906
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA592
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00241337
RAILROAD MEDICARE
—
Enumeration date
11/03/2006
Last updated
12/21/2007
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