Provider Demographics
NPI:1760621213
Name:QUIGLEY, KIERAN L (FNP)
Entity Type:Individual
Prefix:
First Name:KIERAN
Middle Name:L
Last Name:QUIGLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-851-1094
Mailing Address - Fax:314-851-4445
Practice Address - Street 1:12655 OLIVE BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6362
Practice Address - Country:US
Practice Address - Phone:314-851-1094
Practice Address - Fax:314-851-4445
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004005354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2004005354OtherLICENSE