Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 22301 | SC |
NPI | 1003389230 |
---|---|
Provider Name | Krystal Pierce |
First Address | West Columbia, SC 29169 |
Second Address | West Columbia, SC 29169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2019 |
Last Update Date | 09/11/2021 |