1972672293 NPI number — DR. ERNEST PAUL BICKNELL III PSYD

Table of content: DR. ERNEST PAUL BICKNELL III PSYD (NPI 1972672293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972672293 NPI number — DR. ERNEST PAUL BICKNELL III PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BICKNELL
Provider First Name:
ERNEST
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
PSYD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BICKNELL
Provider Other First Name:
SYLVIA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CFO
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1972672293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1890 S 14TH ST
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
FERNANDINA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32034-4740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-432-7833
Provider Business Mailing Address Fax Number:
904-432-7831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1890 S 14TH ST
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
FERNANDINA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32034-4740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-432-7833
Provider Business Practice Location Address Fax Number:
904-432-7831
Provider Enumeration Date:
11/08/2006

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: 103TC0700X , with the licence number:  PY4456 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com