Provider Demographics
NPI:1972837185
Name:PIERSON, JOHNNA L (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:L
Last Name:PIERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOHNNA
Other - Middle Name:L
Other - Last Name:BOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4064 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-2942
Mailing Address - Country:US
Mailing Address - Phone:480-233-4545
Mailing Address - Fax:
Practice Address - Street 1:3210 AVENUE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4303
Practice Address - Country:US
Practice Address - Phone:308-630-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4281363A00000X
NE1551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant