Provider Demographics
NPI:1952926149
Name:PIERCY, VIRGINIA GRACE (MS, CHES)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:GRACE
Last Name:PIERCY
Suffix:
Gender:F
Credentials:MS, CHES
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:PIERCY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CHES
Mailing Address - Street 1:4611 JONATHAN DR
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-8959
Mailing Address - Country:US
Mailing Address - Phone:901-440-9423
Mailing Address - Fax:
Practice Address - Street 1:4611 JONATHAN DR
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-8959
Practice Address - Country:US
Practice Address - Phone:901-440-9423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS31262174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1214764OtherBUSINESS ID