Provider Demographics
NPI:1508858234
Name:PIERSON, MARK N (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:N
Last Name:PIERSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N
Mailing Address - Street 2:SUITE 140W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7506
Mailing Address - Country:US
Mailing Address - Phone:406-238-6540
Mailing Address - Fax:406-238-6599
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:SUITE 140W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-238-6540
Practice Address - Fax:406-238-6599
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT414363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP00264425OtherRR MEDICARE
WY121839500Medicaid
MT000900873OtherBLUECROSS BLUESHIELD
MT4306705Medicaid
MTP00264425OtherRR MEDICARE
MTP74031Medicare UPIN
MT84538Medicare PIN