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General NPI Number Information
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NPI Number | 1932579984
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Entity Type | Individual
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Provider Name | TIERNEY A KEETON-TUCKER DNP, APN, AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/03/2015
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Last Update Date | 03/12/2026
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Provider Practice Location Address
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Address Line | 3737 MARKET ST FL 10
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5545
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Country | US
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Telephone | 215-662-3202
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Fax |
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Provider Business Mailing Address
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Address Line | 3737 MARKET ST FL 10
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City | PHILADELPHIA
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State | PA
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Zip | 19104-5545
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Country | US
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Telephone | 215-662-3202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00686600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP017528
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ00686600
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License Number State | NJ
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