Provider Demographics
NPI:1558786202
Name:PIERCE, LAURYN ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURYN
Middle Name:ROSE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAURYN
Other - Middle Name:ROSE
Other - Last Name:BORGSCHULTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4517 SOUTHLAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3280
Mailing Address - Country:US
Mailing Address - Phone:205-985-4111
Mailing Address - Fax:205-985-4326
Practice Address - Street 1:4517 SOUTHLAKE PKWY
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3280
Practice Address - Country:US
Practice Address - Phone:205-985-4111
Practice Address - Fax:205-985-4326
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-945363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL159642Medicaid