Provider Demographics
NPI:1396727590
Name:PIERCE, JENNIFER ROSE (CFNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:MS
Mailing Address - Zip Code:38873-0400
Mailing Address - Country:US
Mailing Address - Phone:662-438-7474
Mailing Address - Fax:662-438-7760
Practice Address - Street 1:12B NATCHEZ ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:MS
Practice Address - Zip Code:38873
Practice Address - Country:US
Practice Address - Phone:662-438-7474
Practice Address - Fax:662-438-7760
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSS06859Medicare UPIN