Healthcare Provider Details

I. General information

NPI: 1043165939
Provider Name (Legal Business Name): KIMBERLY NICOLE KIERNAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MALABAR RD SE
PALM BAY FL
32907-3040
US

IV. Provider business mailing address

200 MALABAR RD SE
PALM BAY FL
32907-3040
US

V. Phone/Fax

Practice location:
  • Phone: 321-633-3278
  • Fax:
Mailing address:
  • Phone: 321-633-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberAPRN11045768
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11045768
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: