Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 12008018 | IN |
Y | 213EG0000X | General Practice | 12008018 | IN |
NPI | 1003823055 |
---|---|
Provider Name | Mr. Kevin M Pierson |
First Address | New Salisbury, IN 47161-9224 |
Second Address | New Salisbury, IN 47161-9224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |