Individual
JENNIFER NICOLE PICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
CENTRACARE CLINIC ADULT AND PEDIATRIC UROLOGY, 2351 CONNECTICUT AVENUE SOUTH #200, ST CLOUD, MN 56303-2477
(320) 259-1411
(320) 259-8967
Mailing address
CENTRACARE CLINIC ADULT AND PEDIATRIC UROLOGY, 2351 CONNECTICUT AVENUE SOUTH #200, ST CLOUD, MN 56303-2477
(320) 259-1411
(320) 259-8967
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11242
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
08/01/2012
Last updated
01/25/2021
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