Charles Delvon Pickett, IDMT

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

7019 N Litchfield Ave
Luke AFB, 56/Amds
Luke AFB, AZ 85309

Phone

(623) 856-7527

NPI assigned

Jan 31, 2011

Last updated

Aug 30, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314662400000",
    "number": "1043516610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16240 W PIMA ST",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853387927",
            "telephone_number": "480-233-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7019 N LITCHFIELD AVE",
            "address_2": "LUKE AFB, 56/AMDS",
            "city": "LUKE AFB",
            "state": "AZ",
            "postal_code": "85309",
            "telephone_number": "623-856-7527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKETT",
        "first_name": "CHARLES",
        "middle_name": "DELVON",
        "credential": "IDMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-31",
        "last_updated": "2011-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Ohrin-Greipp, MSW, LCSW, BCD
• Curtis Samuel Pacheco, MD
• Cynthia Page
• Grant C Phillips, M.D.
• Nhien Pho
• Jessica Harris Rackley, PA-C
• Daniel Ramsey
• Reba Ray, MD
• Brandy Leigh Renner, PHARMD
• David Repp, PT

• Independent Duty Medical Technicians in Luke AFB, AZ
• Providers in Luke AFB, AZ by specialty
• Independent Duty Medical Technicians in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.