Provider Demographics
NPI:1154150324
Name:OUEDRAOGO, KIERRA
Entity type:Individual
Prefix:
First Name:KIERRA
Middle Name:
Last Name:OUEDRAOGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 MAGNA CARTA BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8392
Mailing Address - Country:US
Mailing Address - Phone:810-394-8479
Mailing Address - Fax:
Practice Address - Street 1:2700 WALKER WAY
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2088
Practice Address - Country:US
Practice Address - Phone:469-801-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRCP020031942279S1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279S1500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredSNF/Subacute Care