Healthcare Provider Details

I. General information

NPI: 1083441018
Provider Name (Legal Business Name): SHONTEL K PIERCE PMHNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2273 S EASON BLVD
TUPELO MS
38804-5900
US

IV. Provider business mailing address

110 JUNIPER CT
TUPELO MS
38801-1203
US

V. Phone/Fax

Practice location:
  • Phone: 662-842-2461
  • Fax:
Mailing address:
  • Phone: 662-251-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number910047
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number910047
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number910047
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number907021
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number910047
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number910047
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: