Individual
MRS. L SHULTIS KIERNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
3401 PGA BLVD, 500B, PALM BEACH GARDENS, FL 33410
(561) 366-0065
(561) 366-0078
Mailing address
PO BOX 31833, PALM BEACH GARDENS, FL 33420-1833
(561) 366-0065
(561) 366-0078
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT674
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890472300
—
FL
01
—
Z1322
BLUE CROSS/ BLUE SHIELD
FL
Enumeration date
10/10/2006
Last updated
10/07/2008
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