Provider Demographics
NPI:1457307324
Name:TIERNEY, MARY PATRICIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PATRICIA
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Other - First Name:
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Mailing Address - Street 1:16555 MANCHESTER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1220
Mailing Address - Country:US
Mailing Address - Phone:636-405-3155
Mailing Address - Fax:636-405-3162
Practice Address - Street 1:16555 MANCHESTER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1220
Practice Address - Country:US
Practice Address - Phone:636-405-3155
Practice Address - Fax:636-405-3162
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO066801363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner