Basic Information
| Provider Information | |||||||||
| NPI: | 1396158929 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | EMILY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 CHERRY OAK LN | ||||||||
| Address2: | |||||||||
| City: | HAUGHTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710378970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187953388 | ||||||||
| FaxNumber: | 8703913874 | ||||||||
| Practice Location | |||||||||
| Address1: | 2522 E 70TH ST | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711054002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182725822 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2014 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 106S00000X | LA | Y |
No ID Information.