Provider Demographics
NPI:1780787895
Name:TIERNEY, KATHY ROSSER (LNP,CNS)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ROSSER
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:LNP,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3825
Mailing Address - Country:US
Mailing Address - Phone:804-819-4236
Mailing Address - Fax:804-819-4266
Practice Address - Street 1:107 S 5TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3825
Practice Address - Country:US
Practice Address - Phone:804-819-4236
Practice Address - Fax:804-819-4266
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB091304106146N00000X
VA0001078773163WP0809X
VA0024165434363LP0808X
VA0015000150364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010347432Medicaid
VAR81342Medicare UPIN