Provider Demographics
NPI:1558914572
Name:MCKIERNAN, DEVEN KENNEDY
Entity Type:Individual
Prefix:
First Name:DEVEN
Middle Name:KENNEDY
Last Name:MCKIERNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 EVELYN ST
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-2183
Mailing Address - Country:US
Mailing Address - Phone:603-703-1920
Mailing Address - Fax:
Practice Address - Street 1:27 EVELYN ST
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-2183
Practice Address - Country:US
Practice Address - Phone:603-703-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7425363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant