Provider Demographics
NPI:1396937371
Name:PIERCE, JESSICA TUCKER (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:TUCKER
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:33501 1ST WAY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6208
Practice Address - Country:US
Practice Address - Phone:253-838-2400
Practice Address - Fax:253-838-2400
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNO368207Q00000X
WABC60107719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0293154OtherLABOR AND INDUSTRY
TX8AL618OtherBCBS
WAP01058244OtherRAILROAD MEDICARE
WA8910810Medicare PIN
WA0293154OtherLABOR AND INDUSTRY
TX8L5175Medicare PIN