Provider Demographics
NPI:1396534756
Name:BURRELL, KIERSTEN TDEJAH
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:TDEJAH
Last Name:BURRELL
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 1:2800 GRAND AVE S APT 111
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2227
Mailing Address - Country:US
Mailing Address - Phone:612-702-1215
Mailing Address - Fax:
Practice Address - Street 1:2800 GRAND AVE S APT 111
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2227
Practice Address - Country:US
Practice Address - Phone:612-702-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator