Provider Demographics
NPI:1952300618
Name:KIERNAN, AUDREY M (CRNA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:M
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HACKETT BLVD
Mailing Address - Street 2:ANESTHESIA GROUP OF ALBANY, PC
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1543
Mailing Address - Country:US
Mailing Address - Phone:518-463-0050
Mailing Address - Fax:518-436-0699
Practice Address - Street 1:5 JOHNSON ROAD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-3003
Practice Address - Country:US
Practice Address - Phone:413-737-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319782367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RA7156Medicare PIN