Provider Demographics
NPI:1033149349
Name:PIERSON, GAYNELL S (MSN, NP)
Entity Type:Individual
Prefix:
First Name:GAYNELL
Middle Name:S
Last Name:PIERSON
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 HADLEY RD STE 190
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1884
Mailing Address - Country:US
Mailing Address - Phone:317-834-5220
Mailing Address - Fax:317-528-8012
Practice Address - Street 1:115 FIELDS ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1492
Practice Address - Country:US
Practice Address - Phone:317-584-0038
Practice Address - Fax:317-834-5469
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001668A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ22163Medicare UPIN