Provider Demographics
NPI:1770234270
Name:KILPATRICK, CIERRA N
Entity Type:Individual
Prefix:
First Name:CIERRA
Middle Name:N
Last Name:KILPATRICK
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 1:1971 EAST BELTLINE AVE
Mailing Address - Street 2:STE 106 #488
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525
Mailing Address - Country:US
Mailing Address - Phone:616-284-1834
Mailing Address - Fax:231-447-1834
Practice Address - Street 1:1971 EAST BELTLINE AVE
Practice Address - Street 2:STE 106 #488
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-284-1834
Practice Address - Fax:231-447-1834
Is Sole Proprietor?:No
Enumeration Date:2022-01-16
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist