Provider Demographics
NPI:1750817680
Name:PIERCE, BRANDI DAWN
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:DAWN
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:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:BURNEYVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:73430-0134
Mailing Address - Country:US
Mailing Address - Phone:580-226-1838
Mailing Address - Fax:
Practice Address - Street 1:15 MONROE ST NE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2025
Practice Address - Country:US
Practice Address - Phone:580-226-1838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator