MEDICARE: KIERSTEN LYNN DIERCKS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1023749363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIERSTEN LYNN DIERCKS MD

Provider Business Mailing Address
First Line	:	231 ALBERT SABIN WAY MSB 1654, ML 0769
Second Line	:	UC EMERGENCY MEDICINE
City	:	CINCINNATI
State	:	OH
Zip	:	45267-0769
Country	:	US
Telephone Number	:	513-558-5281
Fax Number	:

Provider Business Practice Location Address
First Line	:	3188 BELLEVUE AVE
Second Line	:	CENTER FOR EMERGENCY CARE
City	:	CINCINNATI
State	:	OH
Zip	:	45267-0769
Country	:	US
Telephone Number	:	513-558-5281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	03/31/2026

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