Provider Demographics
NPI:1629540323
Name:KEARNEY, SIEARA (WIG CREATOR)
Entity Type:Individual
Prefix:
First Name:SIEARA
Middle Name:
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:WIG CREATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 METEDECONK LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-5404
Mailing Address - Country:US
Mailing Address - Phone:919-769-2971
Mailing Address - Fax:
Practice Address - Street 1:5503 METEDECONK LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-5404
Practice Address - Country:US
Practice Address - Phone:919-769-2971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0517175503Medicaid
NC05175503OtherVICTIMS OF ALOPECIA, CANCER, AND OTHER MEDICAL ISSUES THAT CAUSES HAIR LOSS.