Provider Demographics
NPI:1124491550
Name:KIERNAN, KIRSTEN ASHLEY (LPN)
Entity type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:ASHLEY
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1318
Mailing Address - Country:US
Mailing Address - Phone:347-666-0811
Mailing Address - Fax:
Practice Address - Street 1:21 NASSAU ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1318
Practice Address - Country:US
Practice Address - Phone:347-666-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319114-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse