Provider Demographics
NPI:1174526057
Name:TIERNEY, DARLENE (ARNP)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 MONTGOMERY RD STE 1300
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11140 MONTGOMERY RD STE 1300
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45249-2309
Practice Address - Country:US
Practice Address - Phone:859-331-0774
Practice Address - Fax:859-578-3800
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003443363L00000X
OHAPRN.CNP.0027524363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201069770Medicaid
KY78004918Medicaid
OH0062228Medicaid
500016674OtherPALMETTO GBA-RAILROAD MEDICARE
500016674OtherPALMETTO GBA-RAILROAD MEDICARE
P21694Medicare UPIN
IN201069770Medicaid