Healthcare Provider Details

I. General information

NPI: 1972605715
Provider Name (Legal Business Name): JASON MICHAEL KIERNAN NP, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NEW YORK AVE
OAK RIDGE TN
37830-5212
US

IV. Provider business mailing address

200 NEW YORK AVE STE 200
OAK RIDGE TN
37830-5225
US

V. Phone/Fax

Practice location:
  • Phone: 865-835-5400
  • Fax:
Mailing address:
  • Phone: 865-835-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number41041
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704210566
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704210566
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: