MEDICARE: VIRGINIA GRACE PIERCY MS, CHES

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	174H00000X	Health Educator	31262	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1214764	OTHER	MS	BUSINESS ID

General Provider Information

NPI Number	:	1952926149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA GRACE PIERCY MS, CHES

Provider Business Mailing Address
First Line	:	4611 JONATHAN DR
Second Line	:
City	:	HORN LAKE
State	:	MS
Zip	:	38637-8959
Country	:	US
Telephone Number	:	901-440-9423
Fax Number	:

Provider Business Practice Location Address
First Line	:	4611 JONATHAN DR
Second Line	:
City	:	HORN LAKE
State	:	MS
Zip	:	38637-8959
Country	:	US
Telephone Number	:	901-440-9423
Fax Number	:

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

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	11/27/2023

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