Provider Demographics
NPI:1811872641
Name:KIERAS, STEPHEN JOHN
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOHN
Last Name:KIERAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PETERSHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01366-7500
Mailing Address - Country:US
Mailing Address - Phone:413-800-4988
Mailing Address - Fax:
Practice Address - Street 1:15 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PETERSHAM
Practice Address - State:MA
Practice Address - Zip Code:01366-7500
Practice Address - Country:US
Practice Address - Phone:413-800-4988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2284225364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health