Provider Demographics
NPI:1376549725
Name:KENNEY- KIERAN, MAURA A (ANP-C)
Entity type:Individual
Prefix:MRS
First Name:MAURA
Middle Name:A
Last Name:KENNEY- KIERAN
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 OLD NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2252
Mailing Address - Country:US
Mailing Address - Phone:516-484-6777
Mailing Address - Fax:516-484-0037
Practice Address - Street 1:1405 OLD NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2252
Practice Address - Country:US
Practice Address - Phone:516-484-6777
Practice Address - Fax:516-484-0037
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3033691363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2E3321Medicare ID - Type UnspecifiedPROVIDER I.D.