Provider Demographics
NPI:1821162397
Name:PIERCE, VICKI C (CRNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:C
Last Name:PIERCE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 S JACKSON HWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-5777
Mailing Address - Country:US
Mailing Address - Phone:256-381-6963
Mailing Address - Fax:256-381-6018
Practice Address - Street 1:1120 S JACKSON HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5777
Practice Address - Country:US
Practice Address - Phone:256-381-6963
Practice Address - Fax:256-381-6018
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-047508208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51525528OtherBLUE CROSS BLUE SHIELD
AL891008650Medicaid
AL51525528OtherBLUE CROSS BLUE SHIELD