Healthcare Provider Details

I. General information

NPI: 1255812558
Provider Name (Legal Business Name): TRICIA LYNN KIERNY DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 E PERSHING RD HEALTH CLINIC
CHICAGO IL
60653-2222
US

IV. Provider business mailing address

355 E ERIE ST
CHICAGO IL
60611-3167
US

V. Phone/Fax

Practice location:
  • Phone: 312-567-5686
  • Fax:
Mailing address:
  • Phone: 312-238-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.017961
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: