MEDICARE: DR. TRICIA LYNN KIERNY DNP, APRN, FNP-BC

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	363LF0000X	Family Nurse Practitioner	209.017961	IL

General Provider Information

NPI Number	:	1255812558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRICIA LYNN KIERNY DNP, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	355 E ERIE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3167
Country	:	US
Telephone Number	:	312-238-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	244 E PERSHING RD
Second Line	:	HEALTH CLINIC
City	:	CHICAGO
State	:	IL
Zip	:	60653-2222
Country	:	US
Telephone Number	:	312-567-5686
Fax Number	:

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

Provider Enumeration Date	:	08/24/2018
Last Update Date	:	03/11/2020

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