Provider Demographics
NPI:1497352991
Name:MIKESELL-PIERCE, SCARLETT GLEASON (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:GLEASON
Last Name:MIKESELL-PIERCE
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2021 MERCY WAY STE 102
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-1307
Practice Address - Country:US
Practice Address - Phone:812-218-4630
Practice Address - Fax:812-218-6431
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015118363LF0000X
IN71010598A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300045083Medicaid
IN71010598AOtherSTATE LICENSE
KY7100701280Medicaid