Healthcare Provider Details

I. General information

NPI: 1942617188
Provider Name (Legal Business Name): KIERAN LYSSA NASHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIERAN MCKINNELL

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CENTENNIAL DR STE 101
LIVINGSTON MT
59047-8101
US

IV. Provider business mailing address

16083 SW UPPER BOONES FERRY RD SUITE 300
TIGARD OR
97224-7736
US

V. Phone/Fax

Practice location:
  • Phone: 406-222-0366
  • Fax: 406-222-0366
Mailing address:
  • Phone: 800-219-8835
  • Fax: 503-639-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTP-PT-LIC-9425
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60480124
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: