Provider Demographics
NPI:1871575456
Name:KIERNAN, PATRICIA L (CRNA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 LAUREL STREET
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 13TH ST SE
Practice Address - Street 2:
Practice Address - City:BONDURANT
Practice Address - State:IA
Practice Address - Zip Code:50035-4434
Practice Address - Country:US
Practice Address - Phone:641-486-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD057697367500000X
IL209.009023367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
A013OtherTRIWEST
IA32968OtherWELLMARK BCBS OF IA
430078051OtherPGBA RR MEDICARE
IA0272856Medicaid
IAIA0112OtherJOHN DEERE HEALTH
IA0272856Medicaid