Provider Demographics
NPI:1295195105
Name:PIERCE, MARLISIA (NP)
Entity Type:Individual
Prefix:
First Name:MARLISIA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 BRAND UNA RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE
Mailing Address - State:MS
Mailing Address - Zip Code:39756-9428
Mailing Address - Country:US
Mailing Address - Phone:662-231-3238
Mailing Address - Fax:
Practice Address - Street 1:4913 BRAND UNA RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE
Practice Address - State:MS
Practice Address - Zip Code:39756-9428
Practice Address - Country:US
Practice Address - Phone:662-231-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901436363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health