Provider Demographics
NPI:1104357185
Name:MCKIERNAN, FIONA (MS, RDN, CSG)
Entity type:Individual
Prefix:
First Name:FIONA
Middle Name:
Last Name:MCKIERNAN
Suffix:
Gender:F
Credentials:MS, RDN, CSG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 TAMARA CT
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-4863
Mailing Address - Country:US
Mailing Address - Phone:765-413-6955
Mailing Address - Fax:
Practice Address - Street 1:1505 SHEPARD DR STE 204
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7016
Practice Address - Country:US
Practice Address - Phone:805-621-7302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
997655133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered