Healthcare Provider Details

I. General information

NPI: 1053235002
Provider Name (Legal Business Name): TIMOTHY MICHAEL PIERSON RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

9911 MAIN ST APT 687
BOTHELL WA
98011-3580
US

IV. Provider business mailing address

9911 MAIN ST APT 687
BOTHELL WA
98011-3580
US

V. Phone/Fax

Practice location:
  • Phone: 801-859-2837
  • Fax:
Mailing address:
  • Phone: 801-859-2837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: