Individual
SHASTA PICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
117 S 11TH AVE, LAUREL, MS 39440-4312
(601) 425-3033
(601) 422-0693
Mailing address
117 S 11TH AVE, LAUREL, MS 39440-4312
(601) 425-3033
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
907092
MS
390200000X
Student in an Organized Health Care Education/Training Program
907223
MS
Other
Enumeration date
09/26/2022
Last updated
01/14/2025
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