Basic Information
| Provider Information | |||||||||
| NPI: | 1255678876 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | TYLER | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6839 S CANTON AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184940612 | ||||||||
| FaxNumber: | 9184815170 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 HEALTH CENTER PKWY | ||||||||
| Address2: | |||||||||
| City: | YUKON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730996381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057176800 | ||||||||
| FaxNumber: | 4057177964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 92637 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.