Provider Demographics
NPI:1811020894
Name:PIERCE-GONZALES, KELLY (RN, MSN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:PIERCE-GONZALES
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5005 N. PIEDRAS
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920
Mailing Address - Country:US
Mailing Address - Phone:915-568-5737
Mailing Address - Fax:
Practice Address - Street 1:5005 N. PIEDRAS
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920
Practice Address - Country:US
Practice Address - Phone:915-568-5737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX666668163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health