Provider Demographics
NPI:1669860375
Name:KIERNON, TIMOTHY (MMFT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:KIERNON
Suffix:
Gender:M
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 21ST AVE S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5317
Mailing Address - Country:US
Mailing Address - Phone:615-598-3613
Mailing Address - Fax:
Practice Address - Street 1:2409 21ST AVE S
Practice Address - Street 2:SUITE 102
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5317
Practice Address - Country:US
Practice Address - Phone:615-598-3613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-03
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1043106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist