Provider Demographics
NPI:1821562646
Name:PIERCE, EMILY ROSE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4202
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-305-5733
Practice Address - Street 1:120 EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4201
Practice Address - Country:US
Practice Address - Phone:502-855-7200
Practice Address - Fax:502-855-7201
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300036010Medicaid
KY2248268OtherWELLCARE OF KENTUCKY PROVIDER ID NUMBER
000001356201OtherANTHEM PROVIDER ID NUMBER
3181027OtherHUMANA PROVIDER ID NUMBER
8558195OtherCIGNA PROVIDER ID NUMBER
KYPDZ000000450777OtherAETNA BETTER HEALTH OF KENTUCKY PROVIDER ID NUMBER
KY7100653650Medicaid
7369652OtherUNITED HEALTHCARE PROVIDER ID NUMBER
CS2012600107OtherCARESOURCE PROVIDER ID NUMBER