Provider Demographics
NPI:1235935214
Name:PICKENS, JADE NIA
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:NIA
Last Name:PICKENS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 2ND AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2829
Mailing Address - Country:US
Mailing Address - Phone:916-602-6629
Mailing Address - Fax:
Practice Address - Street 1:3651 2ND AVE APT 8
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2829
Practice Address - Country:US
Practice Address - Phone:916-602-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53935225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant