Provider Demographics
NPI:1073644795
Name:KIERNEY, PHILIP CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:CHRISTIAN
Last Name:KIERNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 27TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-1150
Mailing Address - Country:US
Mailing Address - Phone:253-848-8110
Mailing Address - Fax:253-845-3561
Practice Address - Street 1:105 27TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-1150
Practice Address - Country:US
Practice Address - Phone:253-848-8110
Practice Address - Fax:253-845-3561
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032120208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF44998Medicare UPIN
WAGAB37277Medicare PIN