Provider Demographics
NPI:1508569054
Name:KIERNAN, KACIE (RBT)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 CITY PLAZA WAY APT 3015
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4716
Mailing Address - Country:US
Mailing Address - Phone:407-325-6921
Mailing Address - Fax:
Practice Address - Street 1:2748 S FERN CREEK AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-5539
Practice Address - Country:US
Practice Address - Phone:407-358-0896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician