Healthcare Provider Details

I. General information

NPI: 1275475121
Provider Name (Legal Business Name): MARY KATHRYN ANN PIERCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN PIERCE

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E BROADWAY AVE
THOMAS OK
73669-8321
US

IV. Provider business mailing address

118 E BROADWAY AVE
THOMAS OK
73669-8321
US

V. Phone/Fax

Practice location:
  • Phone: 580-661-3517
  • Fax: 580-846-0017
Mailing address:
  • Phone: 580-661-3517
  • Fax: 580-846-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6232
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: