Provider Demographics
NPI:1336202647
Name:PIERCE, KELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:PIERCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 ASH HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-2983
Mailing Address - Country:US
Mailing Address - Phone:402-450-8399
Mailing Address - Fax:402-858-1281
Practice Address - Street 1:4430 ASH HOLLOW CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-2983
Practice Address - Country:US
Practice Address - Phone:402-450-8399
Practice Address - Fax:402-858-1281
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00403225OtherRAILROAD MEDICARE
NE0107639OtherUHC SHARE ADVANTAGE
NE32254OtherBLUE CROSS BLUE SHIELD
NEP00403225OtherRAILROAD MEDICARE
NE32254OtherBLUE CROSS BLUE SHIELD