Provider Demographics
NPI:1407431067
Name:PIERCE, MCKINLEY NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:MCKINLEY
Middle Name:NICOLE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHARLESFORT WAY
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-8883
Mailing Address - Country:US
Mailing Address - Phone:803-552-5161
Mailing Address - Fax:
Practice Address - Street 1:100 CHARLESFORT WAY
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-8883
Practice Address - Country:US
Practice Address - Phone:803-552-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002091690164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse