Healthcare Provider Details

I. General information

NPI: 1043134489
Provider Name (Legal Business Name): VINCENT PIERCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

22 E INTERSTATE CIR
SALLISAW OK
74955-7003
US

IV. Provider business mailing address

22 E INTERSTATE CIR
SALLISAW OK
74955-7003
US

V. Phone/Fax

Practice location:
  • Phone: 918-315-8653
  • Fax:
Mailing address:
  • Phone: 918-315-8653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: