Provider Demographics
NPI:1699443614
Name:TIERNEY, KIMBERLY L (HAD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 N KINSER PIKE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-1914
Mailing Address - Country:US
Mailing Address - Phone:812-822-2892
Mailing Address - Fax:
Practice Address - Street 1:1833 N KINSER PIKE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-1914
Practice Address - Country:US
Practice Address - Phone:812-822-2892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001559A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist