Individual
IVAN LIONEL PICKLE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
400 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6035
(423) 431-1410
(423) 431-6370
Mailing address
400 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6035
(423) 431-1410
(423) 431-6370
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
32270
TN
Other
Enumeration date
12/16/2016
Last updated
12/16/2016
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