Healthcare Provider Details

I. General information

NPI: 1821746421
Provider Name (Legal Business Name): GERTHY C PIERRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 EAGLE CTR STE 3
O FALLON IL
62269-1948
US

IV. Provider business mailing address

1706 CLOVERDALE DR
EDWARDSVILLE IL
62025-5500
US

V. Phone/Fax

Practice location:
  • Phone: 618-954-7434
  • Fax: 888-533-1766
Mailing address:
  • Phone: 618-954-7434
  • Fax: 888-533-1766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GERTHY CIPUS PIERRE
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP
Phone: 847-852-0145