Healthcare Provider Details

I. General information

NPI: 1326412875
Provider Name (Legal Business Name): LINDA JEAN PIERCE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 4TH ST
LEWISPORT KY
42351-2529
US

IV. Provider business mailing address

PO BOX 1099
OWENSBORO KY
42302-1099
US

V. Phone/Fax

Practice location:
  • Phone: 270-295-3890
  • Fax: 270-295-3891
Mailing address:
  • Phone: 270-295-3890
  • Fax: 270-295-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3009761
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: