Provider Demographics
NPI:1114181294
Name:KIERNAN, JENNIFER (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:10791 KITTY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7747
Mailing Address - Country:US
Mailing Address - Phone:303-838-9165
Mailing Address - Fax:
Practice Address - Street 1:10791 KITTY DR
Practice Address - Street 2:SUITE B
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7747
Practice Address - Country:US
Practice Address - Phone:303-838-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008017058152W00000X
CO2835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1114181294Medicaid
MO1114181294Medicaid