1740797679 NPI number — JOVAN ANDRE PICKNEY I HAIR LOSS SPECIALIST

Table of content: JOVAN ANDRE PICKNEY I HAIR LOSS SPECIALIST (NPI 1740797679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740797679 NPI number — JOVAN ANDRE PICKNEY I HAIR LOSS SPECIALIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PICKNEY
Provider First Name:
JOVAN
Provider Middle Name:
ANDRE
Provider Name Prefix Text:
Provider Name Suffix Text:
I
Provider Credential Text:
HAIR LOSS SPECIALIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740797679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
748 WAYNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTWEGO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70094-4012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-904-9906
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7605 WESTBANK EXPY STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARRERO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70072-2367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-904-9906
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1744P3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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