Healthcare Provider Details

I. General information

NPI: 1427464791
Provider Name (Legal Business Name): GEORGE PIERCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 TEACO RD
KENNETT MO
63857-3239
US

IV. Provider business mailing address

901 HIGHLAND AVE
CARUTHERSVILLE MO
63830-1850
US

V. Phone/Fax

Practice location:
  • Phone: 870-565-9776
  • Fax:
Mailing address:
  • Phone: 573-752-0634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: