Individual
MRS. CARRIE E MCKIERNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
7668 AIRWAYS BLVD, SOUTHAVEN, MS 38671-5304
(901) 683-0055
Mailing address
7668 AIRWAYS BLVD, SOUTHAVEN, MS 38671-5304
(901) 683-0055
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R872656
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06132213
—
MS
Enumeration date
10/01/2010
Last updated
10/21/2014
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