Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP142161 | TX |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP142161 | TX |
NPI | 1619529377 |
---|---|
Provider Name | Mandalynne Pearce |
First Address | Nicholasville, KY 40356-1480 |
Second Address | Dallas, TX 75235-7701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2019 |
Last Update Date | 03/12/2021 |