Provider Demographics
NPI:1134626567
Name:PIERCE, STACY (PMHNP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CLUB MANOR DR STE J
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-7417
Mailing Address - Country:US
Mailing Address - Phone:501-351-1018
Mailing Address - Fax:
Practice Address - Street 1:2001 CLUB MANOR DR STE J
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-7417
Practice Address - Country:US
Practice Address - Phone:501-351-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR074135163WE0003X
AR232740363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency