Provider Demographics
NPI:1073390605
Name:DORTCH, KIERA RAMERE (FNP)
Entity Type:Individual
Prefix:
First Name:KIERA
Middle Name:RAMERE
Last Name:DORTCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN STANTON RD STE 1250
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2076
Mailing Address - Country:US
Mailing Address - Phone:302-623-0200
Mailing Address - Fax:302-623-0117
Practice Address - Street 1:4735 OGLETOWN STANTON RD STE 1250
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2076
Practice Address - Country:US
Practice Address - Phone:302-623-0200
Practice Address - Fax:302-623-0117
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0042300163W00000X
DELG-0012363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse