Healthcare Provider Details

I. General information

NPI: 1609548643
Provider Name (Legal Business Name): MRS. KIERA BACON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. KIERA PETERS

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 EDEN RIDGE CIR
HOOVER AL
35244-4101
US

IV. Provider business mailing address

1395 EDEN RIDGE CIR
HOOVER AL
35244-4101
US

V. Phone/Fax

Practice location:
  • Phone: 205-789-3100
  • Fax:
Mailing address:
  • Phone: 205-789-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6207G
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW007266
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149030634
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: