Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 902707 | MS |
NPI | 1033602834 |
---|---|
Provider Name | Mrs. Jena Leanna Pierce |
First Address | Biloxi, MS 39531-2228 |
Second Address | Gulfport, MS 39501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2018 |
Last Update Date | 21/06/2018 |