MEDICARE: KIMBERLY NICOLE KIERNAN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center	APRN11045768	FL
2	363LF0000X	Family Nurse Practitioner	APRN11045768	FL

General Provider Information

NPI Number	:	1043165939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY NICOLE KIERNAN APRN

Provider Business Mailing Address
First Line	:	200 MALABAR RD SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-3040
Country	:	US
Telephone Number	:	321-633-3278
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MALABAR RD SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-3040
Country	:	US
Telephone Number	:	321-633-3278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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