Healthcare Provider Details

I. General information

NPI: 1073010963
Provider Name (Legal Business Name): KRISTIN M PIERSON RN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 ZEMKE AVE BLDG 1078
TAMPA FL
33621-5023
US

IV. Provider business mailing address

3250 ZEMKE AVE BLDG 1078
TAMPA FL
33621-5023
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9170
  • Fax:
Mailing address:
  • Phone: 813-827-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.386593
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.021717
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: