Provider Demographics
NPI:1295793016
Name:PIERCY, KENNETH TODD (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:TODD
Last Name:PIERCY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N CENTER ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5057
Mailing Address - Country:US
Mailing Address - Phone:828-323-8281
Mailing Address - Fax:828-323-8322
Practice Address - Street 1:415 N CENTER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5057
Practice Address - Country:US
Practice Address - Phone:828-323-8281
Practice Address - Fax:828-323-8322
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000040857174400000X
NC2005002342086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3338766Medicaid
TNMD0000040857OtherMEDICAL LICENSE
NC200500234OtherLICENSE
TNI55277Medicare UPIN
TN3338766Medicare PIN