Healthcare Provider Details

I. General information

NPI: 1255270401
Provider Name (Legal Business Name): SAMANTHA KIERNAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSE KIERNAN DO

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W CHARLESTON BLVD STE 400
LAS VEGAS NV
89102-2320
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD STE 400
LAS VEGAS NV
89102-2320
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: