Provider Demographics
NPI:1841498227
Name:PIERCE, KATHLEEN L (IDC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:L
Last Name:PIERCE
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3279 B. CRUSADER DR.
Mailing Address - Street 2:NAVAL AIR STATION LEMOORE
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245
Mailing Address - Country:US
Mailing Address - Phone:559-997-4314
Mailing Address - Fax:559-997-0297
Practice Address - Street 1:937 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93246-4700
Practice Address - Country:US
Practice Address - Phone:559-998-4314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman