Provider Demographics
NPI:1245982875
Name:PIERCE, JEFFREY DWAIN (FNP-C)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DWAIN
Last Name:PIERCE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 E LOOP 304 STE 50
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-3419
Mailing Address - Country:US
Mailing Address - Phone:936-544-7223
Mailing Address - Fax:
Practice Address - Street 1:1501 E LOOP 304 STE 50
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-3419
Practice Address - Country:US
Practice Address - Phone:936-544-7223
Practice Address - Fax:936-544-8083
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068251363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily