Healthcare Provider Details

I. General information

NPI: 1124111059
Provider Name (Legal Business Name): PAMELA C PIERSKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17310 HWY 64
SOMERVILLE TN
38068
US

IV. Provider business mailing address

17310 HWY 64
SOMERVILLE TN
38068
US

V. Phone/Fax

Practice location:
  • Phone: 901-465-2245
  • Fax: 901-465-8683
Mailing address:
  • Phone: 901-465-2245
  • Fax: 901-465-8683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN0000071423
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: