Healthcare Provider Details

I. General information

NPI: 1457134694
Provider Name (Legal Business Name): NANCY WILDER-PIERCE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 14TH AVE NW SOUTH 4
ARDMORE OK
73401
US

IV. Provider business mailing address

1012 14TH AVE NW SOUTH 4
ARDMORE OK
73401
US

V. Phone/Fax

Practice location:
  • Phone: 580-223-5636
  • Fax:
Mailing address:
  • Phone: 405-808-4194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11027907
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: