Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 37744 | AL |
N | 208D00000X | General Practice Physician | 37744 | AL |
NPI | 1053845594 |
---|---|
Provider Name | Evelina N Pierce |
First Address | Keesler, MS 39533 |
Second Address | Keesler, MS 39533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2017 |
Last Update Date | 13/10/2021 |