Provider Demographics
NPI:1366992091
Name:TIETJEN, KIIRA M (DNP ARNP PMHNP)
Entity type:Individual
Prefix:
First Name:KIIRA
Middle Name:M
Last Name:TIETJEN
Suffix:
Gender:F
Credentials:DNP ARNP PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20006 E KNOX CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99016-9222
Mailing Address - Country:US
Mailing Address - Phone:509-953-6381
Mailing Address - Fax:
Practice Address - Street 1:140 S ARTHUR ST STE 506
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2260
Practice Address - Country:US
Practice Address - Phone:509-934-0245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60658033363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health