Healthcare Provider Details

I. General information

NPI: 1235195520
Provider Name (Legal Business Name): TAWNYA KIERNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 COLLINS DR SUITE 202
MIDDLEBURY VT
05753-8528
US

IV. Provider business mailing address

44 COLLINS DR SUITE 202
MIDDLEBURY VT
05753-8528
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-1338
  • Fax: 802-388-8244
Mailing address:
  • Phone: 802-388-1338
  • Fax: 802-388-8244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number042-0010489
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: