Samantha    Pickett    NP
Contract Details
Ivy Creek Health
Facility name
Provider ID
P000000001
NPI
1063950319
Tax ID
320479195
Effective Date
7/7/2022
Last Updated
7/15/2022
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
82.00
Location Details
Address
6582 Boll Weevil Circle
Enterprise, AL 36330
United States
Phone
Billing Details
Address
6582 Boll Weevil Circle
Enterprise, AL 36330
Billing Phone
334-347-2027
Specialty Type
Nurse Practitioner
Map
Address