Healthcare Provider Details

I. General information

NPI: 1427251941
Provider Name (Legal Business Name): PIERCE FAMILY PRACTICE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 ASH HOLLOW CT
LINCOLN NE
68516-2983
US

IV. Provider business mailing address

4430 ASH HOLLOW CT
LINCOLN NE
68516-2983
US

V. Phone/Fax

Practice location:
  • Phone: 402-450-8399
  • Fax: 402-858-1281
Mailing address:
  • Phone: 402-450-8399
  • Fax: 402-858-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number18104
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20387
License Number StateNE

VIII. Authorized Official

Name: KELLY PIERCE
Title or Position: PRESIDENT
Credential:
Phone: 402-450-8399