Healthcare Provider Details

I. General information

NPI: 1548188295
Provider Name (Legal Business Name): PIERCE BERNARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BLACK COAL DRIVE
FT WASHAKIE WY
82514
US

IV. Provider business mailing address

1704 WESTRIDGE DR
CASPER WY
82604-3366
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-7300
  • Fax: 307-332-0304
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberN4760
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: