Provider Demographics
NPI:1720559651
Name:PIERCE, TRISTYN ADLENA
Entity Type:Individual
Prefix:
First Name:TRISTYN
Middle Name:ADLENA
Last Name:PIERCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506B GIBBS ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-4738
Mailing Address - Country:US
Mailing Address - Phone:334-782-9378
Mailing Address - Fax:
Practice Address - Street 1:6051 W HICKORY GROVE RD
Practice Address - Street 2:
Practice Address - City:LETOHATCHEE
Practice Address - State:AL
Practice Address - Zip Code:36047-5413
Practice Address - Country:US
Practice Address - Phone:334-782-9378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer