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NPI Code Detail

MEDICARE: K TIERNEY LANHAM LLC

MEDICARE: K TIERNEY LANHAM LLC
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
1363L00000XNurse Practitioner
2363LF0000XFamily Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841891645
Entity Type Code : Organization
Provider Name (Legal Business Name) : K TIERNEY LANHAM LLC
Provider Business Mailing Address
First Line : PO BOX 3276
Second Line :
City : EVANSVILLE
State : IN
Zip : 47731-3276
Country : US
Telephone Number : 812-473-0181
Fax Number : 812-473-5822
Provider Business Practice Location Address
First Line : 2120 PAYNE ST
Second Line :
City : LOUISVILLE
State : KY
Zip : 40206-2012
Country : US
Telephone Number : 812-491-1307
Fax Number : 812-492-6498
Authorized Official
Title or Position : OWNER
Name : KATHLEEN TIERNEY LANHAM
Credential : APRN
Telephone Number : 502-552-8597
Provider Enumeration Date : 11/06/2020
Last Update Date : 04/12/2022

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