Provider Demographics
NPI:1891761441
Name:PIERCE, KIMBERLY A (NP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:PIERCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 TRANSIT ROAD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-667-6981
Mailing Address - Fax:
Practice Address - Street 1:5893 CAMP RD
Practice Address - Street 2:SUITE 3
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4470
Practice Address - Country:US
Practice Address - Phone:716-648-7401
Practice Address - Fax:716-648-7421
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303691363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02565319Medicaid