Active NPI
Darla J Pickett, PAC
- Medical Physician Assistant
- Vanceburg, KY
National Provider Identifier
1780657015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA836
- Practice address
- RR 3
Vanceburg, KY 41179-9701 - Phone
- (606) 796-3029
- Fax
- (606) 796-6221
- NPI assigned
- Feb 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA836 | KY | Primary |
Addresses
Primary practice location
RR 3
Vanceburg, KY 41179-9701
Mailing address
PO Box 550
Vanceburg, KY 41179-0550
Phone (606) 796-3029
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9500426300 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130701000287 | TN | Order and Referring Only - Physician Assistant | 2769466697 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2188 | TN | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187654400000",
"number": "1780657015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 550",
"city": "VANCEBURG",
"state": "KY",
"postal_code": "411790550",
"telephone_number": "606-796-3029",
"fax_number": "606-796-6221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "RR 3",
"city": "VANCEBURG",
"state": "KY",
"postal_code": "411799701",
"telephone_number": "606-796-3029",
"fax_number": "606-796-6221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICKETT",
"first_name": "DARLA",
"middle_name": "J",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-08",
"last_updated": "2007-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "KY",
"license": "PA836",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9500426300",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Vanceburg, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.