=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518565357
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY HANNAH PIERCE FNP- C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2020
-----------------------------------------------------
Last Update Date | 10/14/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 FLOYD ST
-----------------------------------------------------
City | KENNETT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63857-2450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-888-4226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 137 COUNTY HIGHWAY 344
-----------------------------------------------------
City | HAYTI
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63851-9145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-379-0399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F09200160
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------