Provider Demographics
NPI:1972605715
Name:KIERNAN, JASON MICHAEL (NP, PHD)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:MICHAEL
Last Name:KIERNAN
Suffix:
Gender:M
Credentials:NP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8539
Mailing Address - Country:US
Mailing Address - Phone:517-546-4210
Mailing Address - Fax:
Practice Address - Street 1:3003 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8539
Practice Address - Country:US
Practice Address - Phone:517-546-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704210566163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse