Provider Demographics
NPI:1518565357
Name:PIERCE, MARY HANNAH (FNP- C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HANNAH
Last Name:PIERCE
Suffix:
Gender:F
Credentials:FNP- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 COUNTY HIGHWAY 344
Mailing Address - Street 2:
Mailing Address - City:HAYTI
Mailing Address - State:MO
Mailing Address - Zip Code:63851-9145
Mailing Address - Country:US
Mailing Address - Phone:573-379-0399
Mailing Address - Fax:
Practice Address - Street 1:201 FLOYD ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2450
Practice Address - Country:US
Practice Address - Phone:573-888-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF09200160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily