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NPI Code Detail

MEDICARE: JENILEE REBECCA TIERNEY RN

MEDICARE: JENILEE REBECCA TIERNEY RN
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
1163W00000XRegistered Nurse1128773KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972006153
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENILEE REBECCA TIERNEY RN
Provider Business Mailing Address
First Line : 1220 GREENUP AVE
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7525
Country : US
Telephone Number : 606-393-1165
Fax Number : 606-393-1775
Provider Business Practice Location Address
First Line : 1220 GREENUP AVE
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7525
Country : US
Telephone Number : 606-393-1165
Fax Number : 606-393-1775
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2018
Last Update Date : 03/14/2018

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