Healthcare Provider Details

I. General information

NPI: 1104382076
Provider Name (Legal Business Name): KACI J PEARCE WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4864 JACKSON ST
MONROE LA
71202-6400
US

IV. Provider business mailing address

4864 JACKSON ST
MONROE LA
71202-6400
US

V. Phone/Fax

Practice location:
  • Phone: 318-330-7167
  • Fax:
Mailing address:
  • Phone: 318-330-7167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP203826
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: