Provider Demographics
NPI:1578027892
Name:TIERNEY, KRISTIE NICOLE
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:NICOLE
Last Name:TIERNEY
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 1:11 MAPLEVIEW ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-6247
Mailing Address - Country:US
Mailing Address - Phone:845-486-4970
Mailing Address - Fax:845-350-4177
Practice Address - Street 1:11 MAPLEVIEW ROAD EXT
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6247
Practice Address - Country:US
Practice Address - Phone:845-486-4970
Practice Address - Fax:845-350-4177
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY752520163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool