Healthcare Provider Details

I. General information

NPI: 1306527809
Provider Name (Legal Business Name): KIERRA LAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 S FASHION BLVD STE 180
MURRAY UT
84107-8135
US

IV. Provider business mailing address

5801 S FASHION BLVD STE 180
MURRAY UT
84107-8135
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-7246
  • Fax:
Mailing address:
  • Phone: 801-262-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number9799775-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: