Provider Demographics
NPI:1790243582
Name:PIERCE, KAITLYN TRAYWICK
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:TRAYWICK
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 1:70 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-9314
Mailing Address - Country:US
Mailing Address - Phone:205-814-9284
Mailing Address - Fax:205-814-9626
Practice Address - Street 1:70 PLAZA DR
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-9314
Practice Address - Country:US
Practice Address - Phone:205-814-9284
Practice Address - Fax:205-814-9626
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-161924363LA2200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse