Provider Demographics
NPI:1114418522
Name:PIERCE, MANDI KRISTINA (DO)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:KRISTINA
Last Name:PIERCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MANDI
Other - Middle Name:KRISTINA
Other - Last Name:LEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:521 MOYE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2849
Practice Address - Country:US
Practice Address - Phone:252-744-3229
Practice Address - Fax:252-744-3924
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-02123207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine