Miranda Mae Pickens, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2021026494 Issued in MO

Practice address

1326 S Service Rd W
Sullivan, MO 63080-2306

Phone

(578) 468-4455

NPI assigned

Aug 2, 2021

Sex

Female

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

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of Missouri, Columbia School of Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Washington Hospital, Washington, MO, CCN 260052

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mpickens113769@directc.mercy.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mercy Clinic East Communities

  • Family Medicine Physician
  • Saint Louis, MO
  • NPI 1043574940
  Medicare reassignment Care Compare group NPD
• Mercy Clinic East Communities

  • Rural Health Clinic/Center
  • Sullivan, MO
  • NPI 1467716928
  NPD
• Mercy Clinic East Communities

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1851335228
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Hospitals East Communities

  dba Mercy Hospital Washington

  • General Acute Care Hospital
  • Washington, MO
  • NPI 1285664177
  Care Compare affiliation

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627862400000",
    "number": "1093488322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1788 POTTERY RD",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630904189",
            "telephone_number": "636-358-2887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1326 S SERVICE RD W",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630802306",
            "telephone_number": "578-468-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKENS",
        "first_name": "MIRANDA",
        "middle_name": "MAE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-02",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2021026494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parkway Pathology Group
• Patients First Health Care LLC
• Patients First Health Care LLC
• Patients First Health Care LLC
• Laura Marie Peregoy
• Prange Riley Optometrists, P.C. (Sullivan Eye Care)
• Premier Health Center, L.L.C.
• Sarah Elizabeth Price, LPC
• Prorehab, PC (Athletico Physical Therapy)
• Christopher Rachocki

• Family Nurse Practitioner in Sullivan, MO
• Providers in Sullivan, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.