MEDICARE: LACEE G PIERCE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP121960	TX
2	363LF0000X	Family Nurse Practitioner	674803	TX

General Provider Information

NPI Number	:	1427312081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEE G PIERCE NP

Provider Business Mailing Address
First Line	:	PO BOX 489
Second Line	:
City	:	MT ENTERPRISE
State	:	TX
Zip	:	75681-0489
Country	:	US
Telephone Number	:	903-822-3076
Fax Number	:	903-822-3079

Provider Business Practice Location Address
First Line	:	106 W RUSK ST
Second Line	:
City	:	MT ENTERPRISE
State	:	TX
Zip	:	75681-7581
Country	:	US
Telephone Number	:	903-822-3076
Fax Number	:	903-822-3079

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2012
Last Update Date	:	08/25/2022

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