Healthcare Provider Details

I. General information

NPI: 1962311647
Provider Name (Legal Business Name): KATE R PIERCE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 BALTIMORE DR UNIT 52
LA MESA CA
91942-4224
US

IV. Provider business mailing address

5715 BALTIMORE DR UNIT 52
LA MESA CA
91942-4224
US

V. Phone/Fax

Practice location:
  • Phone: 724-987-2659
  • Fax:
Mailing address:
  • Phone: 724-987-2659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95041246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: