Provider Demographics
NPI:1124111059
Name:PIERSKI, PAMELA C (FNP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:C
Last Name:PIERSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17310 HWY 64
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068
Mailing Address - Country:US
Mailing Address - Phone:901-465-2245
Mailing Address - Fax:901-465-8683
Practice Address - Street 1:17310 HWY 64
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068
Practice Address - Country:US
Practice Address - Phone:901-465-2245
Practice Address - Fax:901-465-8683
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000071423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3907896Medicaid
TN3701371Medicaid
TN3701371Medicaid
TN3907896Medicaid