Provider Demographics
NPI:1255194320
Name:DUVALL, KIERRA JOANNE (RN, BSN, MS, FNP)
Entity type:Individual
Prefix:
First Name:KIERRA
Middle Name:JOANNE
Last Name:DUVALL
Suffix:
Gender:F
Credentials:RN, BSN, MS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SHADY RUN LN UNIT 109
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2358
Mailing Address - Country:US
Mailing Address - Phone:607-654-3838
Mailing Address - Fax:
Practice Address - Street 1:10 MIRACLE MILE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5851
Practice Address - Country:US
Practice Address - Phone:585-275-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY786187-01163W00000X
NYF353295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse