Healthcare Provider Details

I. General information

NPI: 1457832677
Provider Name (Legal Business Name): KENNETH MCCORD TIERNEY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2018
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 WESTOWN PKWY STE 330
WEST DES MOINES IA
50266-2527
US

IV. Provider business mailing address

7300 WESTOWN PKWY STE 330
WEST DES MOINES IA
50266-2527
US

V. Phone/Fax

Practice location:
  • Phone: 515-650-4730
  • Fax:
Mailing address:
  • Phone: 515-650-4730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number112609
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG193461
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1002304-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: