MEDICARE: NANCY WILDER-PIERCE DNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11027907	FL

General Provider Information

NPI Number	:	1457134694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY WILDER-PIERCE DNP

Provider Business Mailing Address
First Line	:	1012 14TH AVE NW SOUTH 4
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401
Country	:	US
Telephone Number	:	405-808-4194
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 14TH AVE NW SOUTH 4
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401
Country	:	US
Telephone Number	:	580-223-5636
Fax Number	:

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

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	06/15/2026

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