Provider Demographics
NPI:1164029443
Name:GLADDEN, CIERRA L (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CIERRA
Middle Name:L
Last Name:GLADDEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CLUB HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:WV
Mailing Address - Zip Code:25241-8055
Mailing Address - Country:US
Mailing Address - Phone:304-761-4127
Mailing Address - Fax:
Practice Address - Street 1:312 CLUB HOUSE DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:WV
Practice Address - Zip Code:25241-8055
Practice Address - Country:US
Practice Address - Phone:304-761-4127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV107559363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner